Hospital Utilization for Pediatric Asthma in Missouri

With 6.8 million annual visits nationally, respiratory system disorders are second only to injury and poisoning as the primary cause of pediatric emergency department visits. Asthma is an ambulatory care treatable condition that accounts for more than 1 in 4 hospitalizations that originate in the ED for children under the age of 10. The prevalence and costs associated with pediatric asthma in the U.S. are increasing. A recent study estimated that pediatric asthma ED visits cost Medicaid programs across the country more than $272 million in 2010. The same study placed the Medicaid burden of pediatric asthma ED visits in Missouri at 15th highest in the nation, while the total number of children covered by Medicaid in Missouri was 18th highest.

Asthma is the most-commonly diagnosed chronic condition for pediatric patients in hospital settings in Missouri. Throughout fiscal year 2014, more than 304,000 Missouri children ages 0 to 17 were treated in a hospital, with more than 847,000 encounters. More than 27,000 — 9 percent of these children — were diagnosed with asthma during the year.

Based on a systematic review of the evidence-based literature, the Community Guide to Preventive Services found that home-based educational and multi-component environmental interventions aimed at reducing pediatric asthma triggers yielded numerous improvements in health outcomes for children with the disease. The study found that the median number of annual asthma symptom days per child decreased by 21, and the median number of missed school days dropped by 12. In addition, the estimated cost-benefit of these interventions suggested a $5.30 to $14 return for every dollar invested. Based on this evidence,
state and national lawmakers are taking steps to reduce barriers to providing care for children with asthma in nontraditional settings. Following rulemaking from the Centers for Medicare & Medicaid Services, which in 2014 authorized reimbursement for home and community-based asthma intervention services for Medicaid and CHIP beneficiaries, the Missouri General Assembly recently appropriated funds to address home-based triggers of asthma for low-income children in the state.

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