To the Editor.—

The Cabana et al article in the October 2004 issue of Pediatrics, which compares the National Heart, Lung, and Blood Institute recommendations for treatment of pediatric asthma with the quality-of-asthma-care measure developed by the Health Plan Employer Data Set (HEDIS), effectively addresses the limitations of standardized guidelines. The HEDIS asthma measure identifies health plan members with “persistent” asthma if there was 1 emergency-department (ED) visit or inpatient discharge listing asthma as the primary diagnosis, ≥4 outpatient asthma visits with 2 medication-dispensing events, or 4 medication-dispensing events in the year before evaluation. To pass the measure, members with “persistent” asthma must fill a prescription for a qualifying medication (inhaled steroid, leukotriene modifier, etc) in the year of evaluation. Medicaid programs currently use HEDIS criteria to compare state health plans, offering incentives for high scores and disincentives for poor scores.

The population selected in the Cabana...

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