Published online: June 17, 2020
An estimated 25 million Americans have asthma and up to half of these have poor control despite widespread availability of effective treatment. A major contributor to poor control is inadequate adherence to controller therapy. Both poor control and low treatment adherence are associated with an increased risk of severe asthma exacerbations and hospitalizations, as well as substantial clinical and economic burden.
Quality measures are tools used to assess the outcomes and value of healthcare provided. Attainment of quality measures above a certain threshold may be associated with improved patient outcomes and reduced economic burden. The Healthcare Effectiveness Data and Information Set (HEDIS) is a standardized set of measures adopted by most health plans and are used by clinicians to assess and improve the quality of care in their patient populations. Two asthma-specific HEDIS measures currently in use are the Medication Management for People with Asthma (MMA) measure, first reported in 2013, and the Asthma Medication Ratio (AMR), first reported in 2014.
In a recent article published by The Journal of Allergy and Clinical Immunology: In Practice, Mosnaim et al. examined the relationship between attainment of the two HEDIS measures, AMR and MMA, and clinical and economic outcomes of patients with asthma. The authors analyzed data from a claims database linked to ambulatory electronic medical records, containing records from over 60 million patients and detailed information on patient demographics, clinical history, medication use, and visits to healthcare professionals. For patients included in the analysis, average AMR and MMA levels were determined over a 1-year premeasurement period and asthma exacerbations and asthma-related healthcare costs were evaluated during the subsequent 12-month measurement period. Satisfactory quality of care during the premeasurement period was defined according to HEDIS as an AMR ≥0.5 and/or an MMA ≥75%. Patients attaining one or both measures were then compared with those not attaining either. Additionally, the authors also investigated the patient characteristics associated with attainment of each of these two measures.
The authors found that 75% of patients achieved an AMR ≥0.5 in the premeasurement period, whereas only 37% of patients achieved the more stringent MMA threshold of ≥75%. After adjustment for relevant premeasurement covariates, attainment of HEDIS measures was found to be associated with a lower likelihood of exacerbations, significantly improved asthma outcomes, and lower asthma-specific costs. Attainment of MMA and/or AMR was associated with significantly improved clinical outcomes. However, while both MMA and AMR attainment were associated with lower exacerbation costs, only AMR attainment was associated with lower overall asthma related costs. This real-world study highlights the importance of monitoring adherence to treatment in patients with persistent asthma, and indicates the potential value of close adherence monitoring for improving clinical outcomes and reducing costs.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.