HE1 - Effect of a Provider-Focused Asthma Care Quality Improvement Program on Patient-Level Asthma-Related Health Care Costs

Abstract

Enhancing Care for Patients with Asthma (ECPA) is a real-world quality improvement program that has been executed in health centers that serve patients with asthma in Illinois, New Mexico, Texas, and Oklahoma. The ECPA focused on furnishing asthma guidelines-based processes as a structural quality improvement approach. While the ECPA has been implemented in these states since 2013, the translational and sustainable effect on reducing patient-level health care costs is unknown. The study objective was to examine the effect of this multi-state, multi-center quality improvement program on individual-level asthma-related health care costs. This study employed a pretest-posttest quasi-experimental design and utilized administrative claims data from a private insurer providing coverage to patients receiving asthma care from participating health centers. Patients were attributed to a health center if they had at least one asthma claim in a participating center during the 12-month pre-implementation and 12-month active implementation periods. Asthma-related total annual health care costs per patient were determined during pre-implementation, implementation, and post-program completion. Three-level generalized linear mixed models (GLMMs) with lognormal distribution estimated the ECPA effect on annual health care costs and accounted for correlation of repeated outcome measures of each patient and nested health centers. All costs were inflated to constant U.S. dollars. 1,696 patients with asthma were attributed to participating health centers. Asthma-related total annual health care costs decreased from $11,914,326 during 12-month pre-implementation period to $5,544,536 during 12-month implementation period (53.5% cost reduction). GLMMs results found ECPA implementation was associated with a 56.5% reduction in total health care costs (95% CI -60.71%, -51.87%; p-value<.0001); post-program completion was associated with a 57.4% reduction (95% CI -61.83%, -52.44%; p-value<.0001). Asthma quality improvement efforts at the health center level are associated with sustainable reductions in asthma-related ER and total health care costs measured at the patient level.