Estimating the impact of self-management education, influenza vaccines, nebulizers, and spacers on health utilization and expenditures for Medicaid-enrolled children with asthma

Abstract

Introduction We quantify the effect of a set of interventions including asthma self-management education, influenza vaccination, spacers, and nebulizers on healthcare utilization and expenditures for Medicaid-enrolled children with asthma in New York and Michigan. Methods We obtained patients’ data from Medicaid Analytic eXtract files and evaluated patients with persistent asthma in 2010 and 2011. We used difference-in-difference regression to quantify the effect of the intervention on the probability of asthma-related healthcare utilization, asthma medication, and utilization costs. We estimated the average change in outcome measures from pre-intervention/intervention (2010) to post-intervention (2011) periods for the intervention group by comparing this with the average change in the control group over the same time horizon. Results All of the interventions reduced both utilization and asthma medication costs. Asthma self-management education, nebulizer, and spacer interventions reduced the probability of emergency department (20.8–1.5%, 95%CI 19.7–21.9% vs. 0.5–2.5%, respectively) and inpatient (3.5–0.8%, 95%CI 2.1–4.9% vs. 0.4–1.2%, respectively) utilizations. Influenza vaccine decreased the probability of primary care physician (6–3.5%, 95%CI 4.4–7.6% vs. 1.5–5.5%, respectively) visit. The reductions varied by state and intervention. Conclusions Promoting asthma self-management education, influenza vaccinations, nebulizers, and spacers can decrease the frequency of healthcare utilization and asthma-related expenditures while improving medication adherence.