Health Plan Feedback to Physicians Improves Asthma Care

SAN FRANCISCO — What health plans tell physicians can make a difference in the quality of care given to poor children with asthma, according to a study of about 4,500 children covered by 18 Medicaid managed care plans in Tennessee and Washington state.

Two types of communication significantly increased the proportion of children with severe asthma who filled their controller prescriptions, Dr. William O. Cooper reported at the annual meeting of the Pediatric Academic Societies.

The first was feedback about how the provider compared to other physicians with respect to quality-of-care benchmarks.

The other was provider notification of an asthma-related hospitalization or an asthma-related emergency room visit by a child in the physician's panel of patients.

“I think there are things that health plans do in the way they interface with providers that could potentially improve coverage for their children,” Dr. Cooper of Vanderbilt University, Nashville, Tenn., said in an interview at the meeting, which was sponsored by the American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics.

The retrospective cohort study reviewed records from 2000 to 2002 for 3,058 children in Tennessee and for 1,440 children in Washington state. The children, who were aged 2–17 years, had moderate to severe asthma. They were covered by 11 health plans in Tennessee and 7 plans in Washington state.

Investigator interviews with the plans' medical directors determined that nine plans in Tennessee and five in Washington state provided feedback on quality of care to providers. Fewer plans, seven in Tennessee and three in Washington state, provided notification, Dr. Cooper said.

As an example of feedback, Dr. Cooper offered the following paraphrase of an insurer telling a physician, “In our health plan, 70% of children [with asthma] have controller medications. We looked at your panel of patients and only 30% [do]. Here's how you are doing compared to the other providers.”

All told, 1,413 children were in plans that provided neither feedback nor notification, 1,341 in plans that provided only feedback, 215 in plans that provided only notification, and 1,529 in plans that provided feedback and notification.

The study looked at the filling of prescriptions for asthma controllers (inhaled corticosteroids, cromolyn, or leukotriene modifiers) during a 365-day follow-up period.

Dr. Cooper and his coinvestigators at Vanderbilt and the University of Washington, Seattle, reported that children in plans with both components filled their controllers 17.6 days more on average than children in plans with no feedback.

If the plans had one component, either notification or feedback, the benefit was 10.3 more days of filled controllers.

Notification, by itself, resulted in more than 200 days that controllers were filled on average, the most of any option for the population as a whole.

The effects of feedback and notification were most pronounced for children with more severe asthma, as defined by the filling of three or more β-agonist prescriptions in the 6 months prior to their entering the study.

In this population, only 77.4% of children filled their controllers if their health plans did not provide feedback or notification.

The proportion increased to 81.6% with notification and 82.1% with feedback to physicians.

When feedback and notification were both used, 85.5% filled their controllers (odds ratio 1.7, compared with children in plans that provided neither form of communication).

The mean days that controllers were filled also increased from 144 with no communication to 181 with feedback to 327 with notification. On average, children in plans with feedback and notification filled their controllers for 225 days.

Children in plans with both components filled their controllers 17.6 days more on average. DR. COOPER

SAN FRANCISCO — What health plans tell physicians can make a difference in the quality of care given to poor children with asthma, according to a study of about 4,500 children covered by 18 Medicaid managed care plans in Tennessee and Washington state.

Two types of communication significantly increased the proportion of children with severe asthma who filled their controller prescriptions, Dr. William O. Cooper reported at the annual meeting of the Pediatric Academic Societies.

The first was feedback about how the provider compared to other physicians with respect to quality-of-care benchmarks.

The other was provider notification of an asthma-related hospitalization or an asthma-related emergency room visit by a child in the physician's panel of patients.

“I think there are things that health plans do in the way they interface with providers that could potentially improve coverage for their children,” Dr. Cooper of Vanderbilt University, Nashville, Tenn., said in an interview at the meeting, which was sponsored by the American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics.

The retrospective cohort study reviewed records from 2000 to 2002 for 3,058 children in Tennessee and for 1,440 children in Washington state. The children, who were aged 2–17 years, had moderate to severe asthma. They were covered by 11 health plans in Tennessee and 7 plans in Washington state.

Investigator interviews with the plans' medical directors determined that nine plans in Tennessee and five in Washington state provided feedback on quality of care to providers. Fewer plans, seven in Tennessee and three in Washington state, provided notification, Dr. Cooper said.

As an example of feedback, Dr. Cooper offered the following paraphrase of an insurer telling a physician, “In our health plan, 70% of children [with asthma] have controller medications. We looked at your panel of patients and only 30% [do]. Here's how you are doing compared to the other providers.”

All told, 1,413 children were in plans that provided neither feedback nor notification, 1,341 in plans that provided only feedback, 215 in plans that provided only notification, and 1,529 in plans that provided feedback and notification.

The study looked at the filling of prescriptions for asthma controllers (inhaled corticosteroids, cromolyn, or leukotriene modifiers) during a 365-day follow-up period.

Dr. Cooper and his coinvestigators at Vanderbilt and the University of Washington, Seattle, reported that children in plans with both components filled their controllers 17.6 days more on average than children in plans with no feedback.

If the plans had one component, either notification or feedback, the benefit was 10.3 more days of filled controllers.

Notification, by itself, resulted in more than 200 days that controllers were filled on average, the most of any option for the population as a whole.

The effects of feedback and notification were most pronounced for children with more severe asthma, as defined by the filling of three or more β-agonist prescriptions in the 6 months prior to their entering the study.

In this population, only 77.4% of children filled their controllers if their health plans did not provide feedback or notification.

The proportion increased to 81.6% with notification and 82.1% with feedback to physicians.

When feedback and notification were both used, 85.5% filled their controllers (odds ratio 1.7, compared with children in plans that provided neither form of communication).

The mean days that controllers were filled also increased from 144 with no communication to 181 with feedback to 327 with notification. On average, children in plans with feedback and notification filled their controllers for 225 days.

Children in plans with both components filled their controllers 17.6 days more on average. DR. COOPER

SAN FRANCISCO — What health plans tell physicians can make a difference in the quality of care given to poor children with asthma, according to a study of about 4,500 children covered by 18 Medicaid managed care plans in Tennessee and Washington state.

Two types of communication significantly increased the proportion of children with severe asthma who filled their controller prescriptions, Dr. William O. Cooper reported at the annual meeting of the Pediatric Academic Societies.

The first was feedback about how the provider compared to other physicians with respect to quality-of-care benchmarks.

The other was provider notification of an asthma-related hospitalization or an asthma-related emergency room visit by a child in the physician's panel of patients.

“I think there are things that health plans do in the way they interface with providers that could potentially improve coverage for their children,” Dr. Cooper of Vanderbilt University, Nashville, Tenn., said in an interview at the meeting, which was sponsored by the American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics.

The retrospective cohort study reviewed records from 2000 to 2002 for 3,058 children in Tennessee and for 1,440 children in Washington state. The children, who were aged 2–17 years, had moderate to severe asthma. They were covered by 11 health plans in Tennessee and 7 plans in Washington state.

Investigator interviews with the plans' medical directors determined that nine plans in Tennessee and five in Washington state provided feedback on quality of care to providers. Fewer plans, seven in Tennessee and three in Washington state, provided notification, Dr. Cooper said.

As an example of feedback, Dr. Cooper offered the following paraphrase of an insurer telling a physician, “In our health plan, 70% of children [with asthma] have controller medications. We looked at your panel of patients and only 30% [do]. Here's how you are doing compared to the other providers.”

All told, 1,413 children were in plans that provided neither feedback nor notification, 1,341 in plans that provided only feedback, 215 in plans that provided only notification, and 1,529 in plans that provided feedback and notification.

The study looked at the filling of prescriptions for asthma controllers (inhaled corticosteroids, cromolyn, or leukotriene modifiers) during a 365-day follow-up period.

Dr. Cooper and his coinvestigators at Vanderbilt and the University of Washington, Seattle, reported that children in plans with both components filled their controllers 17.6 days more on average than children in plans with no feedback.

If the plans had one component, either notification or feedback, the benefit was 10.3 more days of filled controllers.

Notification, by itself, resulted in more than 200 days that controllers were filled on average, the most of any option for the population as a whole.

The effects of feedback and notification were most pronounced for children with more severe asthma, as defined by the filling of three or more β-agonist prescriptions in the 6 months prior to their entering the study.

In this population, only 77.4% of children filled their controllers if their health plans did not provide feedback or notification.

The proportion increased to 81.6% with notification and 82.1% with feedback to physicians.

When feedback and notification were both used, 85.5% filled their controllers (odds ratio 1.7, compared with children in plans that provided neither form of communication).

The mean days that controllers were filled also increased from 144 with no communication to 181 with feedback to 327 with notification. On average, children in plans with feedback and notification filled their controllers for 225 days.

Children in plans with both components filled their controllers 17.6 days more on average. DR. COOPER