BACKGROUND: Asthma-related urgent care utilizations (ARUCU), including hospitalization, ED visit, or urgent care center visit, indicate asthma symptoms are not well controlled and these utilizations also incur high costs. Medicaid claims data can be used to prospectively identify patients with increased risk for ARUCU in the subsequent year for clinicians and community intervention programs.
METHODS: Using Medicaid claims data, King County children who are on Medicaid in both 2014 and 2015 are selected and their risk of ARUCU in 2015 are examined based on their numbers of claims in urgent care utilization and asthma medication fills in 2014. A risk score is developed based on categorization of these claims.
RESULTS: Of the 103,119 children on Medicaid in both 2014 and 2015, 95,891 had a risk score of 0 and their average risk for subsequent ARUCU is 0.81%. For the 7,228 children with a risk score between 1 and 5, the associated risk ranged from 10.0% to 62.7% with an average risk of 16.7%. The risk score scheme is validated using 2015 and provisional 2016 data with similar results.
CONCLUSIONS: For clinicians and asthma intervention programs that aim to reduce asthma-related urgent care utilization and the associated high costs, Medicaid claims data can be used for identifying children with increased risk for ARUCU in the subsequent year.