Improvement in Asthma Medication Ratio Performance Is Associated With Decreased Rates of Asthma-Coded Emergency Department Visits Over Time
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Vivian Wang, MD, Joseph S. Yusin, MD FAAAAI, William W. Crawford, MD FAAAAI, Randy Nakahiro, PharmD

The Asthma Medication Ratio (AMR) has been shown to associate with improved asthma outcomes in multiple cross-sectional studies of multiple asthma populations and multiple age groups. Here we investigate the longitudinal association of AMR performance with rates of asthma-coded emergency department (ED) visits through time.


This retrospective study examined members of a large health maintenance organization (Kaiser Permanente) in Southern California. Eligible subjects (age 5 – 64) met criteria for HEDIS Persistent Asthma as determined by inpatient and outpatient asthma coding events coupled with pharmacy dispensing data. Each year from 2010 through 2016, the HEDIS Persistent Asthma cohort was identified via electronic medical records. AMR status was determined for each subject. AMR performance was defined as the percentage of subjects in each yearly cohort with AMR > 0.5. AMR performance was then compared year-by-year to the percentage of subjects in each cohort with > 1 asthma-coded ED visit during that particular year.


As AMR performance improved from 52.51% of subjects with AMR > 0.5 in 2010 to 89.02% of subjects with AMR > 0.5 in 2016; the rate of asthma-coded ED visits fell from 0.1499 ED visits per subject in 2010 to 0.0848 ED visits per subject in 2016.


This retrospective longitudinal analysis demonstrates an inverse relationship between AMR performance and rates of asthma-coded ED visits among subjects with HEDIS-defined persistent asthma. As AMR performance increases through time, rates of asthma-coded ED visits decline.