Asthma Care Quality Improvement: A Resource Guide for State Action

Appendix D: Asthma Measures (continued)

Table D.2. State and Local Asthma Measures: Four Selected Quality Improvement Initiatives

Type of measure		Variants of the measure definition	Age group	Geographic scope	Source¹
Provider Care (Process)	Severity Assessment—spirometry	Patients with newly diagnosed asthma (moderate or severe) reported to have spirometry as part of their evaluation	All	City	CASI
		Physicians monitoring spirometry or peak flow during office visits	All	City	CASI
		Percent of people with asthma who have had a spirometry measurement.	All	State	Oregon
	Severity Assessment—spirometry access	Physicians reporting access to spirometry: —Spirometer in office —Referral to an asthma specialist who performs spirometry —No access to spirometry	All	City	CASI
	Severity Assessment—spirometry access	For specialists: Patients with newly diagnosed asthma (moderate or severe) reported to have selected diagnostic techniques as part of their evaluation (percents). Techniques listed: spirometry, chest radiograph, skin testing or radioallergosorbent testing, sinus radiographs, trial of daily peak flow monitoring, sputum examination and stain for eosinophilia	All	City	CASI
	Severity Assessment—peak flow et al.	Patients with newly diagnosed asthma (moderate or severe) reported to have daily peak flow as part of their evaluation	All	City	CASI
		Peak flow measurement at ED discharge	All	City	CASI
		Physicians monitoring: Techniques listed: spirometry or peak flow during office visits, frequency of wheeze/cough, frequency of beta 2-agonist use, activity levels, frequency of disturbed sleep due to asthma symptoms, loss of work/school days due to asthma, spirometry or peak flow, direct observation of inhaler technique, peak flow diary review
		Percent of physicians using peak flow or PFTI: —Acutely symptomatic patient (never, rarely, sometime, often) —Asymptomatic patient (never, rarely, sometimes, often)
		Patients with newly diagnosed asthma (moderate or severe) reported to have selected diagnostic techniques as part of their evaluation. Techniques listed: spirometry, chest radiograph, skin testing or radioallergosorbent testing, sinus radiographs, trial of daily peak flow monitoring, sputum examination and stain for eosinophilia, sinus radiographs, CT of the sinuses, MRI of the sinuses, nasal speculum examination, rhinolaryngoscopy, upper GI for gastroesophageal reflux disease (GERD), esophogeal pH testing for GERD	All	City	CASI
	Doctor visit	Percent of people with persistent asthma who have been seen by a medical practitioner for asthma in the last 12 months	All	State	Oregon
	Doctor visit	Percent of members with persistent asthma who have at least one preventive/ambulatory visit with a primary care physician, pulmonologist, or allergist	All	State health plans	MQIC
	Medications—corticosteroids	Physicians prescribing inhaled steroid (for patients <5 years old, for patients > 5 years old) for patients with moderate persistent symptoms	All	City	CASI
	Medications—corticosteroids	Others listed: —Oral beta-agonist (for patients <5 years old, for patients > 5 years old) —Inhaled beta-agonist (for patients <5 years old, for patients > 5 years old) —Theophylline (for patients <5 years old, for patients > 5 years old) —Systemic steroid (for patients <5 years old, for patients > 5 years old) —Inhaled steroid (for patients <5 years old, for patients > 5 years old) —Cromolyn or nedocromil (for patients <5 years old, for patients > 5 years old)	All	City	CASI
	Medications after ED visit	After ED visit percentage of patients given: —Prescription for systemic steroids —Prescription for inhaled steroids/cromolyn —Prescription for antibiotics	All	City	CASI
	Medications—inhaler	Patients with moderate or severe asthma prescribed a corticosteroid inhaler	All	City	CASI
		Patients with asthma for whom any type of metered-dose inhaler is prescribed	All	City	CASI
		During ED visit, formal training in use of metered-dose inhaler, spacer	All	City	CASI
		Percent of people with persistent asthma who have at least one filled prescription for a daily inhaled anti-inflammatory medication	All	State	Oregon
		Percent of people with persistent asthma who use more than one canister of a short-acting inhaled bronchodilator every two months for one year.	All	State	Oregon
	Written asthma plans	Patients with moderate or severe persistent asthma for whom written treatment plans are routinely developed	All	City	CASI
	Written asthma plans	Percent of people with asthma who have a written asthma action plan	All	State	Oregon
	Asthma education	Percent of people with asthma who have documentation of asthma education	All	State	Oregon
		Physicians' approach to asthma education. Techniques listed: form education program, informal education delivered by nurse or physician, other, do not provide asthma education	All	City	CASI
		During ED visit: —Formal asthma education by physician or nurse —Written asthma educational material	All	City	CASI
		Percent of people with persistent asthma who have received education about their triggers and how to reduce their exposure to them	All	State	Oregon
	NAEPP guidelines	Physicians and NAEPP guidelines: —Heard of NAEPP guidelines (yes/no) —Think NAEPP guidelines are useful (extremely useful, somewhat useful, not very useful, no use at all)	All	City	CASI
	Consultation with asthma specialist	Physician’s likelihood of initiating a consultation with an asthma specialist based on the following event or criteria: hospitalization for asthma, an emergency department visit for asthma, multiple medications with continued symptoms, a life-threatening asthma episode, all patients with mild persistent asthma, all patients with moderate persistent asthma, all patients with severe persistent asthma, atypical signs or symptoms, for a diagnosis in child <3 years old	All	City	CASI
	Consultation with asthma specialist	Percent of people hospitalized for asthma who are seen by an asthma specialist within one month of the hospital discharge date	All	State	Oregon
	Acute exacerbations	Patients who call practice for an acute (not life-threatening) exacerbation are usually: —Told to go to the emergency department —Provided with a same-day office appointment —Scheduled for an appointment within the week —Other	All	City	CASI
	Preventive care—flu vaccine	Percent of people with persistent asthma who have received an influenza immunization in the last 12 months	All	State	Oregon
	Preventive care—allergen testing	Percent of people with persistent non-seasonal asthma who have received allergen testing	All	State	Oregon
Hospital Care (Process)	Standards of care—hospital	Whether a hospital is using the following hospital-wide: —Currently using NAEPP guidelines —Currently using critical pathways	All	City	CASI
	Standards of care—ICU	Whether the hospital is using the following in ICU: —Currently using guidelines —Currently using critical pathways	All	City	CASI
	Standards of care—bedside	Whether care at bedside includes: nebulization, peak flow monitoring, peak flow instruction, evaluation of inhaler technique, inhaled anti-inflammatories, asthma education	All	City	CASI
	Community-based care at hospitals	Percent of hospitals that have: 1. Formal asthma education in outpatient setting 2. Utilization review for asthma 3. Clinical case management program for asthma 4. Home visits as part of asthma management 5. Community-based asthma screening 6. Community-based adult asthma education programs 7. Community-based pediatric asthma education programs 8. School-based asthma education programs	All	City	CASI
Emergency Department Care (Process)	Assessment in ED	Whether assessment in the ED includes: 1. PEFR measurement as part of initial assessment 2. PEFR measurement to document improvement after treatment 3. Pulse oximetry as part of initial assessment 4. Pulse oximetry to document improvement after treatment 5. Arterial blood gas as part of initial assessment 6. Arterial blood gas as part of assessment of severe cases 7. Chest radiograph for patients wheezing for the first time 8. Chest radiograph for patients with wheezing and fever 9. Chest radiograph when diagnosis of asthma is in doubt	All	City	CASI
	Treatment in ED	1. Average time asthma patients spent in ED 2. Average time asthma patients spent in ED before disposition 3. Percentage of patients receiving: —IV or po steroids used within the first hour —IV or po steroids used at any time during ED care —Theophylline therapy at any time during ED care —Supplemental oxygen at any time during ED care —Treatment for >4 hours 4. Percentage of EDs reporting: —Availability of respiratory therapy, both day and night —The first medication given for asthma attack (beta-agonist by nebulizer, beta-agonist by metered-dose inhaler)	All	City	CASI
	Follow up after ED visit	Percent of patients given a specific followup appointment	All	City	CASI
		Percent of people with one emergency department visit for asthma who are seen by a medical practitioner within one month of the emergency department visit date	All	State	Oregon
		Percent of people with two emergency department visits for asthma in 12 months who are seen by an asthma specialist within one month of the most recent emergency department visit	All	State	Oregon
Managed Care Organizations (Enabling factors)	Management	1. MCOs offering an asthma education program 2. MCOs offering an asthma case management program 3. MCOs offering an asthma disease management program	All	City	CASI
Managed Care Organizations (Enabling factors)	Benefits	Asthma-specific covered benefits: —Medications —Spacer devices —Peak flow meters —Nebulizers —Asthma education —Pillow/mattress covers —Smoking cessation programs —Smoking cessation medication —HEPA filter/cleaner —Dehumidifier —Home assessment	All	City	CASI
Patient Care—Process	Asthma knowledge	Reported as percentage sampled who answered the question correctly: 1. Asthma cannot be cured 2. Vaporizer is good treatment 3. Asthma limits exercise 4. Need for asymptomatic asthma visits 5. Common reason for school absences 6. Asthma runs in families 7. Asthma is mainly an emotional illness 8. Asthma resolves if attacks stop 9. Where to go for treatment 10. Asthma onset always in childhood 11. Signs: shortness of breath 12. Signs: chest tightness 13. Signs: severe headaches 14. Signs: nocturnal cough 15. Signs: wheezing with exercise 16. Triggers: furry pets 17. Triggers: mosquito bites 18. Triggers: dampness 19. Triggers: cockroaches 20. Triggers: poor diet 21. Triggers pollen 22. Hospitalizations are preventable 23. Symptoms are preventable 24. Adequacy of OTC medications 25. Asthma is a serious disease 26. Asthma care is expensive 27. See doctor immediately for attack 28. Appropriateness of ED for treatment 29. Addiction to asthma medicines 30. Overprotective mothers and asthma
		Percent of people with asthma who has knowledge of asthma medication use and what do in case of an exacerbation.	All	State	Oregon
		Percent of people with asthma who affirm receipt of information about asthma and treatment techniques.	All	State	Oregon
		Percent of people with asthma who report high levels of confidence in understanding and using this information.	All	State	Oregon
		Percent of people with asthma who report behavior consistent with having received and understood this information.	All	State	Oregon
	Environmental triggers	Percent of people with persistent asthma with documentation they have been asked at least once about home and occupational exposures to: —Dust-mites —Animal allergens —Tobacco smoke —Exercise-induced bronchospasm	All	State	Oregon
Mortality (Outcome)	Mortality rates	Mortality rates: —By age and gender —By borough	Children	City	NYCCAI
Avoidable events (Outcome)	Emergency/Urgent care	Emergency department visits per 1000 members with asthma.	All	State health plans	MQIC
	Relapse rate	Percentage of asthma patients estimated to relapse within 7 days.	All	City	CASI
	Hospitalizations	Hospitalization rates: —By age —Comparison of New York City to New York State —Trends 1990-2000 —Distribution by age group —Leading causes of hospitalizations in children 0-14 —By age and gender —By income (ZIP code areas) —Distribution by payer —Total charges by payer —Average length of stay —By borough —By neighborhood —By ZIP code —By month and age	Children	City	NYCCAI
Other dimensions (Prevalence)	Prevalence	Self-reported lifetime prevalence for adults age 18 and over: —By age —By race/ethnicity —By borough —By neighborhood	Children	City	NYCCAI
Other dimensions (Prevalence)	Prevalence	School-based prevalence: —By gender —By income (ZIP code areas) —By borough —By neighborhood	Children	City	NYCCAI
Other dimensions (Behavior)	Smoking	Percent of people with asthma who currently do not smoke cigarettes.	All	State	Oregon
Other dimensions (Behavior)	Smoking	Percent of non-smokers with asthma who are not exposed to tobacco smoke in the home.	All	State	Oregon

¹ Key to Sources:
CASI = Chicago Asthma Surveillance Initiative (Weiss KB, Grant EN. The Chicago Asthma Surveillance Initiative: As
Oregon = Guide to Improving Asthma Care in Oregon (Oregon Health Division, 2005; http://www.dhs.state.or.us/publichealth/asthma/guideor.cfm)
MQIC = Michigan Quality Improvement Initiative Guideline: Management of Persistent Asthma (MQIC, 2005; http://www.mqic.org/meas.htm)
NYCCAI = New York City Childhood Asthma Initiative (Garg, et al, 2003)

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Page last reviewed October 2014
Page originally created September 2012

Internet Citation: Appendix D: Asthma Measures (continued). Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD. https://archive.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/asthmaqual/asthmacare/appendix-d2.html