The following article is a part of conference coverage from the National Association of Pediatric Nurse Practitioners (NAPNAP) 42nd National Conference on Pediatric Health Care, held virtually from March 24 to March 27, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurse practitioners in pediatrics. Check back for more from NAPNAP 2021.
Early recognition of uncontrolled asthma through pharmacy and administrative claims has been used to improve care and prevent asthma attacks. Use of the Asthma Risk Panel Report (ARPR) can help nurse practitioners (NPs) identify and serve high risk children who need asthma follow-up visits, inhalation instructions, care management, or a home environmental assessment for trigger reduction. With this information in hand, NPs can arrange follow-up visits to provide preventative asthma services to prevent frequent asthma attacks, according to a poster presented virtually at the National Association of Pediatric Nurse Practitioners Annual Meeting (NAPNAP 2021).
“Children with uncontrolled asthma experience frequent exacerbations leading to a high use of acute health services, school absenteeism, and personal and societal cost,” reported Tammy Rood, DNP, CPNP-PC, AE-C, a pediatric nurse practitioner in the Pediatric Pulmonary Medicine and Allergy Divisions at the University of Missouri School of Medicine in Columbia. “Nationwide, approximately 50% of children with current asthma are uncontrolled. Nurse practitioners need approaches to help identify children who are at high-risk for exacerbations to deliver preventive asthma care through outpatient visits.”
To help identify at-risk patients, the researchers used the ARPR, a population-based panel report derived from Missouri Medicaid administrative claims. Risk indicators such as frequent asthma acute care visits and risky medication patterns including medication overuse (ie, short-acting beta-agonists or systemic/oral steroids) or underuse of inhaled corticosteroids, are used to identify patients with uncontrolled asthma who need services, she noted (Table 1).
Table 1. Risk Indicators in the Asthma Risk Panel Report
|• The number of asthma patients under the clinician’s care|
|• Percentage of controlled vs uncontrolled asthma|
|• Medication dispensing patterns|
|• Missed opportunities for outpatient care|
|• Rate of inhalation training (CPT 94664)|
|• Eligibility for health home enrollment for monthly care management services and priority level preventive services, including a home environmental assessment and asthma self-management education|
Health care providers are given a POPte (Proportion of Outpatient + Preventive Visits to total encounters) value from 0% to 100%, with 0% indicating that all care is taking place in the emergency room or hospital and 100% indicating that all asthma care
is provided through outpatient or preventive encounters. The POPte scores ranged widely from 49% to 93% across 20 providers, indicating great potential for improvement, according to Dr Rood.
The score “encourages providers to adopt best asthma practices and use preventive services to reduce acute care visits and risky medication use,” said Dr. Rood. Providers enrolled in asthma telementoring through Project ECHO (Extension for Community Health Outcomes) demonstrated marked improvement in POPte and other asthma indicators, she added.
“We are fortunate in Missouri to have access to Medicaid administrative claims, which many states do not have,” Dr. Rood said in an interview. “We have evaluated a small number of participants, which did show a significant decline in emergency room visits. We continue to refine the panel report and the indicators needed to best assist providers to identify at-risk children and improve asthma outcomes.”
Visit Clinical Advisor’s meetings section for complete coverage of NAPNAP 2021.
Rood T, Francisco B. Using pharmacy claims to identify high risk children needing asthma care. Poster presented virtually at: NAPNAP 2021: March 24-27, 2021. EP-P129.