475 - Quality of asthma care and outcomes among children in a highly rural state

Publication Number: 475.6482

Liyan Mazahreh, UAMS, Little Rock, AR, United States; Chary Akmyradov, Arkansas Children's Hospital, Little Rock, AR, United States; Tamara Perry, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Stacie M.. Jones, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Akilah A. Jefferson, University of Arkansas for Medical Sciences, Little Rock, AR, United States

Background: Asthma is the most common chronic respiratory disease of childhood. The Asthma Medication Ratio (AMR) is a commonly used quality metric to assess asthma control, medication adherence, and outcomes with a low AMR assoicated with risk for poor asthma outcomes. A modified AMR (m-AMR), using electronic health record (EHR) data rather than claims data, has been used to assess the risk of asthma exacerbations longitudinally.

Objective: This study aims to quantify the relationship between a m-AMR and adverse asthma outcomes among children in a rural state.

Design/Methods: The Arkansas Children’s Hospital (ACH) EHR was used for a retrospective cohort study including children aged 0-18 years with asthma identified during any type of medical event in calendar years 2017-2020. The primary outcome was adverse asthma outcomes (asthma-related ED visits, urgent care visits, and hospitalizations) during 2017-2020. The m-AMR was calculated for each year using medication prescription records. Additionally, we evaluated the relationship between the change in m-AMR over time and adverse outcomes.

Results: The cohort (n= 3430) was 60.7% male, 50.3% were 5-11 years old, 33.2% White, 49.2% Black, 17.6% Other race and ethnicity, and 13.9% Hispanic. Of those, 28.2% had an adverse outcome overall (across all years), 2.3% in 2017, 11.8% in 2018, 12.8% in 2019, 7.1% in 2020. The m-AMR varied significantly across demographic and clinical factors. Low m-AMR ( < 0.5) was significantly associated with Black race, age < 5 years, asthma-related ED visits and hospitalizations, and very low child opportunity (state-normed COI). High m-AMR (0.5) was significantly associated with English as the primary language, age >5 years, and higher COI levels. Every 0.1 unit increase in m-AMR reduced the odds of adverse outcome by 19.4% from 2017-2020.

Conclusion(s): AMR can be modified for use in EHR analysis to identify children at high-risk for asthma-related adverse outcomes. We identified significant differences in m-AMR by race, age, primary language, healtcare utilization, and child opportunity. Further, we found that increasing m-AMR was inversely associated with adverse outcomes. This study, conducted in a highly rural state, supports prior work showing that multiple non-clinical factors such as race, language, and opportunity play a role in asthma outcomes, particularly among medically and socially disadvantaged children. Future strategies should focus on population-based frameworks that address differences related to these factors and that may require population-based context for success.