Variability in asthma quality and costs in children with different Medicaid insurance plans in Maricopa County

Matthew Rank, Natalie Landman, Gevork Harootunian, Michelle Winscott, Neil Jain, Keith Frey, Gena Wilson, Rupali Drewek, Lilia Parra-Roide, Charlton Wilson, Robert Smoldt, Denis Cortese

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To describe the variation in asthma quality and costs among children with different Medicaid insurance plans. Methods: We used 2013 data from the Center for Health Information and Research, which houses a database that includes individuals who have Medicaid insurance in Arizona. We analyzed children ages 2–17 years-old who lived in Maricopa County, Arizona. Asthma medication ratio (AMR, a measure of appropriate asthma medication use), outpatient follow-up within 2 weeks after asthma-related hospitalization (a measure of continuity of care), asthma-related hospitalizations, and all emergency department (ED) visits were the primary quality metrics. Direct costs were reported in 2013 $US dollars. We used one-way analysis of variance to compare the health plans for AMR and per member cost (total, ER, and hospital), and the chi-squared test for the outpatient follow-up measure. We used coefficient of variation to identify variation of each measure across all individuals in the study. Results: In 2013, 90,652 children in Maricopa County were identified as having asthma. The average patient-weighted AMR for children with persistent asthma was 0.35, well short of the goal of ≥0.70, and only 36% of hospitalized asthma patients had outpatient follow-up within 2 weeks of hospitalization. AMR, total costs, and ED costs varied significantly (p <.0001) when comparing health plans while hospital costs and outpatient follow-up showed no significant variation. Conclusions: Targeting appropriate medication use for asthma may help reduce variation, improve outcomes, and increase healthcare value for children with asthma and Medicaid insurance in the US.

Original languageEnglish (US)
Pages (from-to)152-159
Number of pages8
JournalJournal of Asthma
Issue number2
StatePublished - Feb 1 2019


  • Continuity of care
  • healthcare utilization, Medicaid insurance, medication adherence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine


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