Abstract Background Asthma related healthcare utilization remains a leading cause of preventable emergency department (ED) visits and hospitalizations. Despite effective asthma maintenance therapy, oral corticosteroid (OCS) use is common, is associated with significant side effects, and reflects suboptimal asthma control. Existing asthma performance measures emphasize maintenance controller use including inhaled corticosteroids and adherence rather than OCS burden, leaving steroid-reliant care unflagged. Using prescription claims data, we developed a new performance measure of OCS use (OCS Stewardship Measure) in asthma patients to determine whether it is predictive of future outcomes, responsive to year-to-year change, and actionable to improve care. Method We conducted a retrospective cohort study using administrative claims from Blue Cross Blue Shield of Michigan, provided by the Michigan Value Collaborative. Patients (≥2 years old on 1/1/2023) with asthma diagnosis and pharmacy claims data in 2022 through 2024 were included. Patients with chronic conditions requiring systemic steroids for non-asthma treatment (e.g. autoimmune), and steroid prescriptions associated with non-asthma diagnoses (e.g. dermatitis) were excluded. OCS prescriptions were categorized as 0, 1, ≥2 in 2023 and the primary outcome was asthma related ED visits and hospitalizations in 2024. We also evaluated how year-over-year changes in OCS was associated with subsequent healthcare utilization. Analysis was adjusted for age, sex, Charlson Comorbidity Index (CCI), and controller/reliever prescriptions. Adult and pediatric patients were analyzed separately. Results The cohort included 30,079 patients: 23,063 adults (mean age 50±16.3) and 7,016 children (mean age 9.4±4.5). Compared to those with no OCS prescriptions in 2023, patients with ≥2 prescriptions had significantly higher risk of ED visits or hospitalizations in 2024 (OR 2.36; 95% CI 2.00-2.78). This risk increased with more OCS prescriptions (Figure 1). Additionally, patients with ≥2 OCS prescriptions in 2022 but lowered to 0 or 1 OCS prescriptions in 2023 had significantly lower asthma related healthcare utilization in 2024 (OR 0.49; 95% CI 0.37-0.65) compared to patients that maintained ≥2 OCS prescriptions. In adults, 21.1% of patients with ≥2 OCS prescriptions n = 4,039 (17.5%) in 2023 did not have an inhaled corticosteroid controller fill. Results were similar in the pediatric population. Conclusion The OCS Stewardship Measure can be calculated using administrative claims data to reliably identify high-risk asthma patients likely to have subsequent healthcare utilization, reflect clinical changes, and reveal actionable care gaps. Tracking OCS use could enable health systems to more effectively monitor asthma care at a population level. This abstract is funded by: Blue Cross Blue Shield of Michigan (BCBSM) Value Partnership Program
Qiu et al. (2026) studied this question.