Asthma population management: development and validation of a practical 3-level risk stratification scheme

Am J Manag Care. 2004 Jan;10(1):25-32.


Objective: To define and validate a practical risk stratification scheme based on administrative data for use in identifying patients at high, medium, and low risk of requiring emergency hospital care for asthma.

Study design: Retrospective cohort.

Patients and methods: Predictors in 1999 were evaluated in relation to 2000 asthma emergency hospital care (any asthma hospitalization or emergency department visit) in a training set (n = 8789, 2000 emergency hospital care = 5.5%) and a testing set (n = 6104, 2000 emergency hospital care = 7.9%). Logistic regression was used to assign risk points in the training set, and positive and negative predictive values, sensitivities, and specificities were calculated in the training and testing sets.

Results: High risk was defined as asthma emergency hospital care in the previous year or use of >14 beta-agonist canisters and oral corticosteroid use; medium risk was defined as no emergency hospital care but use of either >14 beta-agonist canisters or oral corticosteroids; and low risk was defined as none of the above. For the high-risk groups in the training and testing sets, positive predictive values were 12.9% and 22.0%, sensitivities were 24.8% and 25.4%, specificities were 90.3% and 92.0%, and negative predictive values were 95.4% and 93.2%, respectively. The medium-risk groups identified another 32.6% of patients in the training set and 28.3% in the testing set requiring subsequent asthma emergency hospital care.

Conclusion: This simple risk stratification scheme is useful for identifying patients from administrative data who are at increased risk of experiencing emergency hospital care for asthma.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Adrenergic beta-Agonists / therapeutic use
  • Adult
  • Asthma / epidemiology*
  • Asthma / therapy*
  • California / epidemiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Disease Management
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Services Research
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Managed Care Programs / statistics & numerical data
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment / methods*


  • Adrenal Cortex Hormones
  • Adrenergic beta-Agonists