Discovering Reasons for High Asthma Emergency Department Visit Rates Among Maine Adults with Medicaid

BACKGROUND:  MaineCare (Maine’s Medicaid program) is the most common payer of asthma emergency department (ED) visits in Maine, with more than one-third of all asthma ED visits in the state occurring among MaineCare beneficiaries. Adult MaineCare beneficiares have a higher prevalence of asthma than other Mainers, but analysis of all-payer claims data show that even among Mainers with asthma, those who are MaineCare beneficiaries are significantly more likely to have ED visits for asthma compared to those with other health coverage. The Maine Asthma Program sought to discover reasons for increased asthma ED rates among adult MaineCare beneficiaries with asthma in order to create interventions to reduce asthma ED visits in this population.   

METHODS:  We analyzed 2006-2010 data from the Maine Behavioral Risk Factor Surveillance System and Adult Asthma Call-Back Survey -- random-digit-dial landline telephone surveys of non-institutionalized adults -- to examine asthma control, healthcare utilization, medication use, asthma education, home and work environment, and tobacco smoke exposure among MaineCare beneficiaries compared to all other Maine adults.  SAS survey procedures were used to analyze the complex sample survey data; all data were weighted to adjust for non-response and be more representative of all Maine adults.

RESULTS:  MaineCare beneficiaries were significantly more likely to have very poorly controlled asthma (37.6% vs. 20.4%) and to have at least one urgent doctor visit for asthma in the past year (30.0% vs. 17.9%) than other Maine adults, but were also more likely to have the recommended two or more routine office visits for asthma (44.8% vs. 25.0%). MaineCare beneficiaries with asthma were significantly more likely to currently smoke (38.8% vs. 11.6%), have home tobacco smoke exposure (37.4% vs. 13.1%), and have work-related asthma triggers (61.5% vs. 49.2%, among the employed) compared to all other Maine adults.  Medication use, asthma education, receipt of annual flu shot, and other home environment triggers were similar between the groups. 

CONCLUSIONS:  Increased asthma ED visits among MaineCare beneficiaries are likely driven by poorer asthma control in this population. Tobacco smoke exposure and work environment triggers are likely contributors to this poorer control. The Maine Asthma Program is using these findings to work with the MaineCare program to design interventions to reduce asthma ED visits in this population.