In a study funded by the Managed Health Care Association (MHCA), a group of major U.S. employers with affiliated health plans, the Hopkins team used information from two patient surveys to develop a "risk index" for undesirable outcomes. The best predictors were visits to an emergency room within the past two years and cancelled activities within the past month.
"We need to confirm the applicability of our findings, but it may be possible to use these models to help doctors target high-risk patients for more education about such things as medication compliance and staying away from substances that trigger asthma attacks," says RobinYurk, M.D., postdoctoral fellow at the School of Medicine.
In a poster prepared for the American Lung Association/American Thoracic Society International Conference in Chicago, Yurk and her Hopkins colleagues at the School of Public Health said non-white race, asthma symptoms between outright attacks, recent use of oral steroids and more than 8 puffs a day of inhaled asthma drugs known as beta agonists also emerged as potent predictors of future attacks.
The Hopkins team used data from a survey mailed to managed care plan members, and a followup survey taken a year later.
"We selected 4,742 patients with moderate to severe asthma and used data from the first survey to predict responses in the second," says Yurk. "We identified 13 questions that can be combined to identify patients at risk for several undesirable outcomes, including hospital use, emergency room use, lost work days and severe asthma symptoms."
The different models allow the problem of risk to be analyzed from different perspectives: employer, managed care organization, or physician/patient.
Asthma affects an estimated 12 million Americans, including 4 million children, and kills 5,000 patients annually. Researchers estimate the annual direct costs for hospitalization and treatment at $3.6 billion, and indirect costs including lost works days and premature death at $2.6 billion.
"We hope the new models will be tested in the broader population, including patients not enrolled in managed care," says Albert Wu, M.D., associate professor of health policy and management in the Hopkins School of Public Health and senior author on the study.
Yurk and Wu took their data from MHCA's Management System Project Consortium, which is directed by Don Steinwachs. Other authors were Gregory Diette, M.D., a postdoctoral fellow; and Anne Skinner, an expert in survey research.