Asthma Care Quality Improvement

Table 4.1. Dimensions of Asthma Care Measurement

Category Measure Description Importance>
Provider Care (Process Measures)
A.1. Asthma severity assessment Asthma severity is assessed by health professional during a patient visit. Treatment strategies for asthma involve a stepwise approach in which the level of therapy increases with the asthma severity (see Module 1 for severity classifications). An adequate assessment of severity is thus a key step in determining appropriate management and treatment plans for patients with asthma (JCAHO, 2004). Asthma severity can be assessed by a health professional using a spirometer and taking a history of symptoms. Assessments are important for adjusting appropriate therapy and medication for long-term control of asthma.
A.2. Asthma medications Use of anti-inflammatory medications (such as inhaled corticosteroids) to control asthma for patients with persistent asthma. There are two types of medications used for asthma: Anti-inflammatory long-term controller medication and quick-acting relief medication for asthma attacks (bronchodilators). Daily anti-inflammatory medications (or long-term controller medications) can prevent exacerbations and chronic symptoms for patients with persistent asthma. Inhaled corticosteroids are the most effective anti-inflammatory medication available for treating the underlying inflammation of persistent asthma (CDC & NHLBI, 2003). They do not have the serious side effects of oral steroids, especially when properly inhaled. Use of specific asthma medication and frequency of use are measures that show what percentage of asthma patients use medication and how well they understand how to use their medication. However, measures of medication use should be interpreted with knowledge of the severity level.
A.3. Asthma management plans Patients with asthma who are given a written/documented asthma management plan. The management goals for controlling asthma can vary for different asthma patients. This is especially important for patients with persistent asthma. Therefore, it is important for providers and patients to discuss goals and how to control asthma. Writing a management plan helps clarify expectations for treatment and provides patients with an easy reference for remembering how to manage their asthma (CDC & NHLBI, 2003).
A.4. Self- management support or patient education Patients and their families have discussed with their doctors how to manage their asthma and avoid asthma triggers. Patient education is a key component of asthma care. Because management of asthma generally occurs outside of the doctor's office after assessment and acute care, it is important for asthma patients and their caregivers to be informed about their asthma. The aim is to help patients manage their asthma in the context of their daily lives. Patients and their families should know how to recognize symptoms, how to avoid triggers, when and how to use asthma medication and delivery devices, and when to seek care. At a minimum, competent asthma education enlists and encourages family support, includes instructions on self-management skills, and is integrated with routine ongoing care (CDC & NHLBI, 2003).
A.5. Planned care for asthma Planned care visits for asthma are completed at least every 6 months, or more frequently for more severely ill patients or those with comorbidities. Patients with asthma should seek care at least every 1-6 months depending on asthma severity and ability to control symptoms. Patients with asthma may experience varying symptoms and severity, which may require adjustments in therapy. Because of the nature of asthma, variable exposure to allergens and irritants, or insufficient adherence to a medication regimen, regular followup is recommended (CDC & NHLBI, 2003).
Asthma patients are given influenza vaccines. During planned care visits, persons with asthma may require preventive care for other common conditions since they are more vulnerable to other health complications due to their condition. Flu vaccination is recommended for persons with asthma to prevent asthma exacerbation due to influenza. Smoking is also a trigger for many asthma patients since smoke (first- or second-hand) can exacerbate difficulty breathing.
Asthma patients are given smoking cessation counseling.
Patient/Parent Self-Care (Process Measures)
B.1. Environmental modifications Percent of asthma population that has been advised by a health professional to change things in home, school, or work to reduce asthma triggers. Environmental and occupational factors contribute to illness and disability from asthma. Decreases in lung function and a worsening of asthma have been associated with exposure to allergens, indoor pollutants (for example, tobacco smoke), and ambient air pollutants (for example, ozone, sulfur dioxide, nitrogen dioxide, acid aerosols, and particulate matter). The patient's or caregiver's awareness of environmental triggers is an important part of their ability to manage their asthma and prevent asthma attacks. There are numerous ways to reduce asthma attacks by making changes in the home, school or work such as reducing exposure to dust by removing carpeting or using special linens in the bedroom, removing pets, not smoking, etc. However, the extent to which these changes can be made depends on the patient's ability to control these environments. Because not all changes are feasible, health providers must understand their patients' environments and circumstances to give advice.
Percent of asthma population exposed to environmental tobacco smoke.
Outcome Measures
C.1. Daily symptom burden Number of days in the past month with limited activity due to asthma. Asthma attacks and symptoms are indicators of the ineffectiveness of treatment and management of the disease. Also, asthma attacks or symptoms can have a significant impact on a person's ability to participate in normal daily activities. Sensitivity to environmental triggers can keep a person with asthma from going to work or school. Assessing the number of days with limited activity helps to evaluate the burden of the disease on the population. Also, frequent use of beta-agonists for relief of asthma attacks is an indicator of ineffective long-term control of asthma. By monitoring the frequency of asthma attacks, symptoms, and use of quick-relief medications, access to and effectiveness of treatment can be assessed across the population diagnosed with asthma.
Number of school/work days missed in the past month due to asthma.
Number of days with sleeping difficulty in the past month due to asthma.
Number of days with (or free of) asthma symptoms in the past month.
Frequency of use of beta-agonists for people with asthma.
C.2. Acute avoidable events due to asthma (exacerbations) Rate of asthma hospitalizations in the State. Hospitalization for asthma can often be prevented when the condition is properly managed. Hospitalizations, emergency department visits, or urgent care visits may reflect poor asthma management by patients and their health care providers. Hospitalizations are also highly disruptive to patients and families and increase the cost of asthma care for State Medicaid agencies and State employee benefits programs. Avoidable hospitalization measures are shown in Module 1, Table 1.2.
Rate of emergency or urgent care visits for asthma in the State.
Enabling Factor
D.1. Access to care People with asthma who have health insurance coverage in the State. Health insurance coverage influences the propensity of patients to seek health care in the management of a chronic disease. Without health insurance, families are likely to cut down on routine medications and/or doctor visits for monitoring the condition and to have poorer results in managing it.
Other Factors
D.2. Prevalence Percent of population that has ever been told they have asthma by a doctor or health professional. Though not modifiable (i.e., primary prevention of asthma is poorly understood), prevalence information provides an indication of the burden of disease on the population and health system.
Percent of population that currently has asthma.
Percent of population that has had asthma attack in past 12 months.
Page last reviewed October 2014
Internet Citation: Table 4.1. Dimensions of Asthma Care Measurement. October 2014. Agency for Healthcare Research and Quality, Rockville, MD.