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Appendix D: Asthma Measures

Asthma Care Quality Improvement: A Resource Guide for State Action

Appendix D: Asthma Measures

Table D.1. Inventory and Comparison of Asthma Measures from 12 National Sources,1 Grouped by Type of Measure

Type of measureVariants of the measure definitionAge groupGeographic scopeSource1
Provider Care
(Process)
Severity AssessmentAsthma severity classification done during asthma visit.ChildrenNationalNICHQ
Percent of patients with severity assessment for asthma at last visit.AllNationalHRSA
Rate of asthma patients with a documented asthma severity level.AllHospitalsJCAHO-APMIG
Percentage of patients who were evaluated during at least one office visit for the frequency (numeric) of daytime and nocturnal asthma symptoms.AllNationalAMA PCPI (NQF approved)
Severity AssessmentSpirometer measurements used in diagnosis.AllHospitalsJCAHO
Severity Assessment—peak flowEstablishment of a personal best peak flow measurement.AllHospitalsJCAHO
Percent of moderate and severe persistent asthma population older than five years who have established a personal best Peak Flow through multiple readings.AllNationalHRSA
Percent of asthma population that uses a peak flow meter at home.AllNationalMEPS
Medications—timingTime since last asthma medication taken.AllState/NationalNAS
MedicationsPercent of asthma population that takes any prescription medication for asthma.AllNationalMEPS
Percentage of all patients with mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication(inhaled corticosteroid) or an acceptable alternative treatment.AllNationalAMA PCPI (NQF approved)
Medications—NSAIDSUse of anti-inflammatory medications to control asthma.ChildrenNationalNICHQ
AllHospitalsJCAHO-ORYX
Percent of asthma patients who use asthma medications.AllNationalHRSA
Rate of medications use for those with a severity assessment of having persistent asthma.AllHospitalsJCAHO-APMIG
Medications—corticosteroidsUse of systemic corticosteroids in patients with an acute exacerbation.AllHospitalsJCAHO
Percent of asthma patients who use corticosteroids for long-term control of asthma.AllNationalHEDIS
Percent of asthma patients who use corticosteroids in inpatient hospital setting.ChildrenHospitalsJCAHO-ORYX
Medications—frequencyFrequency of use of asthma medication in the past 30 days.AdultsState/NationalBRFSS
Medications—inhalerNumber of puffs taken each time.AllState/NationalNAS
Number of times per week.AllState/NationalNAS
Percent of asthma population that has ever use a prescription inhaler.AllState/NationalNAS
Number of full canisters used in the past 3 months.AllState/NationalNAS
Use before exercising.AllState/NationalNAS
Use any steroid inhalers for asthma.AllNationalMEPS
Percent of population that has had a health professional show them how to use an inhaler.AllState/NationalNAS
Medications—specific typePercent of asthma population that takes [NAME OF MEDICATION] for their asthma (self assessment).AllState/NationalNAS
Medications—nebulizerPercent of asthma population that uses a nebulizer with their asthma medication.AllState/NationalNAS
Medications—OTCPercent of asthma population that has ever used over-the-counter medication for asthma.AllState/NationalNAS
Medications—formsPercent of asthma population taking asthma medications in pill form.AllState/NationalNAS
Percent of asthma population taking asthma medications in syrup form.AllState/NationalNAS
Length of time used for each medication.AllState/NationalNAS
Medications—relieversUse of relievers for inpatient childhood asthma.ChildrenHospitalsJCAHO-ORYX
Documented asthma management planRate of asthma patients with a documented self-management plan.AllHospitalsJCAHO-APMIG
Percent that has taken a class on how to manage asthma.AllState/NationalNAS
Asthma management plan given to family.ChildrenNationalNICHQ
Asthma management plan is discussed with and understood by patient/family.ChildrenHospitalsJCAHO-ORYX
Percent with a printed asthma management plan.AllState/NationalNAS
Patients with self-management goals during asthma visit.ChildrenNationalNICHQ
Percent with self-management goal at last visit.AllNationalHRSA
Patient educationHealth professional discussed how to better control asthma at time of hospital discharge.AllState/NationalNAS
Rate of asthma patients who have been educated on asthma triggers and avoidance.AllHospitalsJCAHO-APMIG
Percent of asthma population whose doctor or health professional taught them what to do during an asthma attack.AllState/NationalNAS
Percent of asthma population whose doctor or health professional taught them how to use a peak flow meter.AllState/NationalNAS
Percent of asthma population whose doctor or health professional taught them how to recognize early signs or symptoms of an asthma episode.AllState/NationalNAS
Routine checkupsPercent of patients with planned care visits.ChildrenNationalNICHQ
Average number of doctor visits for routine checkup for asthma.AdultsState/NationalBRFSS
AllState/NationalNAS
Doctor visitsTime since last talked to a doctor or other health professional about your asthma.AllState/NationalNAS
Prevention—depressionPercent of asthma population screened for depression.AllNationalHRSA
Prevention—fluPercent of asthma population that has had a flu shot in the past 12 months.AdultsState/NationalBRFSS
One dose of flu vaccine administered in past 15 months.All HRSA
Prevention smoking cessation counselingPercent of asthma population that has been advised by a health professional to quit smoking.AdultsState/NationalBRFSS
Rate of smoking cessation advice/counseling with caregivers of children with asthma.ChildrenHospitalsJCAHO-APMIG
Patient satisfactionPatients satisfaction with asthma care.ChildrenNationalNICHQ
Patient/Parent
Self-Care
(Process)
Behavior—environmental
assessment
Percent of asthma population exposed to environmental tobacco smoke.AllNationalHRSA
Percent of asthma population evaluated on triggers other than environmental
tobacco smoke (dust, mites, cats, dogs, molds/fungi, cockroaches).
AllNationalHRSA
Percent of asthma population whose work environment worsens their asthma.AllState/NationalNAS
Percent of asthma population that has seen cockroaches in the home.AllState/NationalNAS
Percent of asthma population with mold or musty odor inside home in the past
30 days.
AllState/NationalNAS
Percent of asthma population that uses gas for cooking.AllState/NationalNAS
Percent of asthma population with unvented gas logs or gas fireplace or gas
stove in the home.
AllState/NationalNAS
Percent of asthma population that has smoking in the home in the past week.AllState/NationalNAS
Percent of asthma population that has a wood burning stove in the home.AllState/NationalNAS
Behavior—environmental
modification devices
Percent of asthma population that uses air cleaner or purifier inside the home.AllState/NationalNAS
Uses a bathroom fan that vents to the outside.AllState/NationalNAS
Uses a dehumidifier to reduce moisture inside the home.AllState/NationalNAS
Uses an exhaust fan when cooking.AllState/NationalNAS
Behavior—environmental
modification
Percent of asthma population that has been advised by a health professional
to change things in home, school or work to improve asthma.
AllState/NationalNAS
Percent of asthma population that have carpeting or rugs in the bedroom.AllState/NationalNAS
Percent of asthma population that use mattress covers made for controlling
dust mites.
AllState/NationalNAS
Percent of asthma population that use pillow covers made for controlling dust
mites.
AllState/NationalNAS
Percent of asthma population with indoor pets.AllState/NationalNAS
Percent of asthma population that allows pets in the bedroom.AllState/NationalNAS
Percent of asthma population that washes sheets and pillowcases in hot
water.
AllState/NationalNAS
Behavior—smokingPercent of asthma population that has smoked at least 100 cigarettes in their
entire life.
AllState/NationalNAS
Percent of asthma population that now smokes every day, some days or not a
all.
AllState/NationalNAS
Daily Symptom
Burden (Outcome)
Activity limitation daysNumber of days unable to work or carry out usual activities due to asthma in the past 12 months.AllState/NationalNAS
AdultsState/NationalBRFSS
Number of school/work days missed.AllState/NationalNAS
Average number of days lost at work or school in the past 30 days.AllNationalHRSA
Average number of missed school days in the past two months.ChildrenNationalNICHQ
Percent of asthma population that experiences limitation in usual activities due to asthma.AllState/NationalNAS
Symptom—frequencyPercent of people with asthma who have had an episode of asthma or an asthma attack during the past 12 months.AllState/NationalNAS
AdultsState/NationalBRFSS
AllNationalMEPS
AllNationalNHIS
Number of days with symptoms of asthma in the past 30 days.AllState/NationalNAS
AdultsState/NationalBRFSS
Number of asthma attacks in the past 3 months.AllState/NationalNAS
Percent of people with asthma who have symptoms all the time.AllState/NationalNAS
Time since last had symptoms of asthma.AllState/NationalNAS
Symptom—durationDuration of most recent asthma attack.AllState/NationalNAS
Percent of people with asthma who had a longer/shorter recent attack compared to last attack.AllState/NationalNAS
Symptom—freeNumber of symptom-free days in the past two weeks.AllState/NationalNAS
AllNationalHRSA
Number of symptom-free days among patients with persistent asthma.ChildrenNationalNICHQ
Symptom—sleepNumber of days when symptoms of asthma make it difficult to stay asleep in
the past 30 days.
AllState/NationalNAS
AdultsState/NationalBRFSS
Avoidable EventsEmergency/Urgent care

Number of visits for urgent treatment of worsening asthma symptoms or an asthma episode or attack besides ED or urgent care.

AllState/NationalNAS
AdultsState/NationalBRFSS
Percent of children with asthma who have had an acute asthma visit in the past two months.ChildrenNationalNICHQ
Return to hospital with same asthma diagnosis within 7 days following emergency department visit or observation stay.ChildrenHospitalsJCAHO-ORYX
Percent of asthma patients who have had a visit to an ED/Urgent care office for asthma in the past 6 months.ChildrenNationalNICHQ
AllNationalHRSA
AllNationalHRSA
Number of emergency department visits in the past 12 months.AllState/NationalNAS
AdultsState/NationalBRFSS
HospitalizationsReturn to hospital with same asthma diagnosis within 7 days following inpatient discharge.ChildrenHospitalsJCAHO-ORYX
Return to hospital with same asthma diagnosis with 30 days following inpatient discharge.ChildrenHospitalsJCAHO-ORYX
Return to hospital with same asthma diagnosis within 30 days following emergency department visit or observation stay.ChildrenHospitalsJCAHO-ORYX
Average length of stay for discharges from short-stay hospitals for asthma.AllNationalNHDS
Risk-adjusted length of stay (LOS) for childhood asthma patients.ChildrenHospitalsJCAHO-ORYX
Have stayed overnight in a hospital due to asthma in the past 12 months.AllState/NationalNAS
Hospital admissions for asthma per 100,000 population.ChildrenState/NationalHCUP
AdultsState/NationalHCUP
Percent of children with asthma who have had a hospitalization for asthma in the past six months.ChildrenNationalNICHQ
Rate of discharge from short-stay hospitals for asthma.AllNationalNHDS
Other Dimensions
(Prevalence)
Prevalence—lifetime

Percent of population that has ever been told they have asthma by a doctor or
health professional.

ChildrenState/NationalBRFSS
AdultsState/NationalBRFSS
AllState/NationalNAS
AllNationalMEPS
AllNationalNHIS
Age at diagnosis.AdultsState/NationalBRFSS
Prevalence—currentPercent of people that has ever been told they have asthma by a doctor or health professional that still have asthma.ChildrenState/NationalBRFSS
AdultsState/NationalBRFSS
AllState/NationalNAS
Prevalence—registryNumber of asthma patients in the registry.ChildrenNationalNICHQ
AllNationalHRSA
Prevalence—family
history
 AllState/NationalNAS
 AllState/NationalNAS
 AllState/NationalNAS
Other Dimensions
(Demographic)
DemographicsHighest level of school completed.AllState/NationalNAS
Zip code.AllState/NationalNAS
Total combined income in household.AllState/NationalNAS
Height.AllState/NationalNAS
Weight.AllState/NationalNAS
Birth weight.AllState/NationalNAS
Percent of asthma population with low birth weight.AllState/NationalNAS
Percent of asthma population of Hispanic or Latino origin.AllState/NationalNAS
Percent of asthma population that is white, black, American Indian/Alaska Native, or Asian/Pacific Islander.AllState/NationalNAS
Percent of asthma population whose household has been without telephone service for 1 week or more in the past 12 months.AllState/NationalNAS
AccessPercent of people with asthma that have any kind of health care coverage,
including health insurance, prepaid plans such as HMOs, or government plans
such as Medicare.
AllState/NationalNAS
Percent of people with asthma that did not have any health insurance or
coverage.
AllState/NationalNAS
EmploymentPercent of asthma population that is currently employed/unemployed.AllState/NationalNAS
Percent of asthma population unable to work for health reasons/disabled.AllState/NationalNAS

1. Sources:
AMA PCPI = American Medical Association Physician Consortium for Performance Improvement, NQF Ambulatory Care Measures, 2005
NICHQ = National Initiative for Children's Health Care Quality monthly measures for children with asthma for practices participating in initiative
HRSA = Health Resources and Services Administration, Bureau of Primary Health Care, Disparities Collaboratives—Asthma
JCAHO-APMIG = Joint Commission on Accreditation of Healthcare Organizations, Asthma Performance Measurement Implementation Guide
NAS = National Asthma Survey, CDC, 2003
JCAHO-ORYX = JCAHO ORYX initiative on hospital performance for implementation in 2006
BRFSS = Behavioral Risk Factor Surveillance Survey, CDC, 2004
HEDIS = Healthplan Employer Data and Information Set, National Committee for Quality Assurance, 2003
HCUP = Health Care Utilization Project, Agency for Healthcare Research and Quality, 2004
NHDS = National Hospital Discharge Survey, CDC, 2001
MEPS = Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, 2000
NHIS = National Health Interview Survey, CDC, 2001

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Current as of September 2009
Internet Citation: Appendix D: Asthma Measures: Asthma Care Quality Improvement: A Resource Guide for State Action. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/asthmaqual/asthmacare/appendix-d.html