Pediatric asthma is a costly and complex disease with proven interventions to prevent exacerbations. Finding the patients at highest risk of exacerbations is paramount given limited resources. Insurance claims identify all outpatient, inpatient, emergency, pharmacy, and diagnostic services. The objective was to develop a risk score indicating the likelihood of asthma exacerbation within the next year based on prior utilization. A retrospective analysis of insurance claims for patients 2 to 18 years in a network in Massachusetts with 3 years of continuous enrollment in a commercial plan. Thirty-six potential predictors of exacerbation in the third year were assessed with a stepwise regression. Retained predictors were weighted relative to their contribution to asthma exacerbation risk and summed to create the Asthma Exacerbation Risk (AER) score. In a cohort of 28,196 patients, there were 10 predictors associated with the outcome of having an asthma exacerbation in the next year that depend on age, meeting the Healthcare Effectiveness Data and Information Set persistent asthma criteria, fill patterns of asthma medications and oral steroids, counts of nonexacerbation outpatient visits, an exacerbation in the last 6 months, and whether spirometry was performed. The AER score is calculated monthly from a claims database to identify potential patients for an asthma home-visiting program. The AER score assigns a risk of exacerbation within the next 12 months using claims data to identify patients in need of preventive services.

中文翻译：

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使用索赔数据开发和验证哮喘恶化风险评分

小儿哮喘是一种昂贵且复杂的疾病，经过验证的干预措施可以防止病情恶化。鉴于资源有限，找到病情加重风险最高的患者至关重要。保险索赔涵盖所有门诊、住院、急诊、药房和诊断服务。目的是根据之前的使用情况制定一个风险评分，表明明年哮喘恶化的可能性。对马萨诸塞州网络中 2 至 18 岁、连续参加商业计划 3 年的患者的保险索赔进行回顾性分析。通过逐步回归评估了第三年恶化的 36 个潜在预测因素。保留的预测因子根据其对哮喘恶化风险的贡献进行加权，并求和以创建哮喘恶化风险（AER）评分。在 28,196 名患者的队列中，有 10 个与明年哮喘恶化结果相关的预测因子，这些预测因子取决于年龄、满足医疗保健有效性数据和信息集持续性哮喘标准、哮喘药物和口服类固醇的填充模式，非恶化门诊就诊次数、过去 6 个月内的恶化情况以及是否进行了肺活量测定。AER 评分每月根据索赔数据库计算得出，以识别哮喘家访计划的潜在患者。AER 评分使用索赔数据来确定未来 12 个月内病情恶化的风险，以确定需要预防性服务的患者。