Limits of the HEDIS Criteria in Determining Asthma Severity for Children

Objective: Although the Health Plan Employer Data Information Set (HEDIS) is a common method for evaluating the quality of asthma care, its accuracy in characterizing persistent asthma in children is unknown. The objective of this study was to compare the assessment of asthma severity (persistent vs nonpersistent asthma) using the HEDIS criteria versus clinical criteria using National Heart, Lung, and Blood Institute (NHLBI) guidelines.

Methods: In a cross-sectional study, we analyzed baseline data from interviews with the parents of 896 children who had asthma and participated in a randomized controlled trial. Patients had an active clinical diagnosis of asthma, were between 2 and 12 years of age, and had no other pulmonary diseases. Patients had persistent asthma by parent report according to the HEDIS criteria when, within the last year, they had 1 asthma inpatient admission or emergency department visit or 4 asthma medication dispensing events, or 4 outpatient asthma visits and at least 2 asthma medication dispensing events. Patients had persistent asthma by parent report according to the NHLBI criteria when, within the last 2 months, they had nighttime asthma symptoms >2 nights/mo or daytime asthma symptoms >2 days/wk. We calculated the sensitivity of each HEDIS criterion, separately and then combined, using the NHLBI criteria as a gold standard.

Results: On the basis of HEDIS criteria, 656 (73%) patients had persistent asthma, compared with 338 (38%) using NHLBI criteria. Although the HEDIS criteria for persistent asthma were fairly sensitive (0.89), they were not very specific (0.70). For children without daily controller medications (n = 346), the sensitivity was even lower (0.45), but the specificity was similar (0.68). We found that the test characteristics were fairly consistent across different age group strata (2-4, 5-9, and 10-12 years of age).

Conclusions: HEDIS criteria used to determine the quality of asthma care should be interpreted with caution. Although the criteria for persistent disease-used to determine which children require daily controller medications-are fairly sensitive, they are not very specific and include children who may not require such medications.