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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 measure Variants of the measure definition Age group Geographic scope Source1
Provider Care
(Process) 		Severity Assessment Asthma severity classification done during asthma visit. Children National NICHQ
Percent of patients with severity assessment for asthma at last visit. All National HRSA
Rate of asthma patients with a documented asthma severity level. All Hospitals JCAHO-APMIG
Percentage of patients who were evaluated during at least one office visit for the frequency (numeric) of daytime and nocturnal asthma symptoms. All National AMA PCPI (NQF approved)
Severity Assessment Spirometer measurements used in diagnosis. All Hospitals JCAHO
Severity Assessment—peak flow Establishment of a personal best peak flow measurement. All Hospitals JCAHO
Percent of moderate and severe persistent asthma population older than five years who have established a personal best Peak Flow through multiple readings. All National HRSA
Percent of asthma population that uses a peak flow meter at home. All National MEPS
Medications—timing Time since last asthma medication taken. All State/National NAS
Medications Percent of asthma population that takes any prescription medication for asthma. All National MEPS
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. All National AMA PCPI (NQF approved)
Medications—NSAIDS Use of anti-inflammatory medications to control asthma. Children National NICHQ
All Hospitals JCAHO-ORYX
Percent of asthma patients who use asthma medications. All National HRSA
Rate of medications use for those with a severity assessment of having persistent asthma. All Hospitals JCAHO-APMIG
Medications—corticosteroids Use of systemic corticosteroids in patients with an acute exacerbation. All Hospitals JCAHO
Percent of asthma patients who use corticosteroids for long-term control of asthma. All National HEDIS
Percent of asthma patients who use corticosteroids in inpatient hospital setting. Children Hospitals JCAHO-ORYX
Medications—frequency Frequency of use of asthma medication in the past 30 days. Adults State/National BRFSS
Medications—inhaler Number of puffs taken each time. All State/National NAS
Number of times per week. All State/National NAS
Percent of asthma population that has ever use a prescription inhaler. All State/National NAS
Number of full canisters used in the past 3 months. All State/National NAS
Use before exercising. All State/National NAS
Use any steroid inhalers for asthma. All National MEPS
Percent of population that has had a health professional show them how to use an inhaler. All State/National NAS
Medications—specific type Percent of asthma population that takes [NAME OF MEDICATION] for their asthma (self assessment). All State/National NAS
Medications—nebulizer Percent of asthma population that uses a nebulizer with their asthma medication. All State/National NAS
Medications—OTC Percent of asthma population that has ever used over-the-counter medication for asthma. All State/National NAS
Medications—forms Percent of asthma population taking asthma medications in pill form. All State/National NAS
Percent of asthma population taking asthma medications in syrup form. All State/National NAS
Length of time used for each medication. All State/National NAS
Medications—relievers Use of relievers for inpatient childhood asthma. Children Hospitals JCAHO-ORYX
Documented asthma management plan Rate of asthma patients with a documented self-management plan. All Hospitals JCAHO-APMIG
Percent that has taken a class on how to manage asthma. All State/National NAS
Asthma management plan given to family. Children National NICHQ
Asthma management plan is discussed with and understood by patient/family. Children Hospitals JCAHO-ORYX
Percent with a printed asthma management plan. All State/National NAS
Patients with self-management goals during asthma visit. Children National NICHQ
Percent with self-management goal at last visit. All National HRSA
Patient education Health professional discussed how to better control asthma at time of hospital discharge. All State/National NAS
Rate of asthma patients who have been educated on asthma triggers and avoidance. All Hospitals JCAHO-APMIG
Percent of asthma population whose doctor or health professional taught them what to do during an asthma attack. All State/National NAS
Percent of asthma population whose doctor or health professional taught them how to use a peak flow meter. All State/National NAS
Percent of asthma population whose doctor or health professional taught them how to recognize early signs or symptoms of an asthma episode. All State/National NAS
Routine checkups Percent of patients with planned care visits. Children National NICHQ
Average number of doctor visits for routine checkup for asthma. Adults State/National BRFSS
All State/National NAS
Doctor visits Time since last talked to a doctor or other health professional about your asthma. All State/National NAS
Prevention—depression Percent of asthma population screened for depression. All National HRSA
Prevention—flu Percent of asthma population that has had a flu shot in the past 12 months. Adults State/National BRFSS
One dose of flu vaccine administered in past 15 months. All   HRSA
Prevention smoking cessation counseling Percent of asthma population that has been advised by a health professional to quit smoking. Adults State/National BRFSS
Rate of smoking cessation advice/counseling with caregivers of children with asthma. Children Hospitals JCAHO-APMIG
Patient satisfaction Patients satisfaction with asthma care. Children National NICHQ
Patient/Parent
Self-Care
(Process)		 Behavior—environmental
assessment		 Percent of asthma population exposed to environmental tobacco smoke. All National HRSA
Percent of asthma population evaluated on triggers other than environmental
tobacco smoke (dust, mites, cats, dogs, molds/fungi, cockroaches).		 All National HRSA
Percent of asthma population whose work environment worsens their asthma. All State/National NAS
Percent of asthma population that has seen cockroaches in the home. All State/National NAS
Percent of asthma population with mold or musty odor inside home in the past
30 days.		 All State/National NAS
Percent of asthma population that uses gas for cooking. All State/National NAS
Percent of asthma population with unvented gas logs or gas fireplace or gas
stove in the home.		 All State/National NAS
Percent of asthma population that has smoking in the home in the past week. All State/National NAS
Percent of asthma population that has a wood burning stove in the home. All State/National NAS
Behavior—environmental
modification devices		 Percent of asthma population that uses air cleaner or purifier inside the home. All State/National NAS
Uses a bathroom fan that vents to the outside. All State/National NAS
Uses a dehumidifier to reduce moisture inside the home. All State/National NAS
Uses an exhaust fan when cooking. All State/National NAS
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.		 All State/National NAS
Percent of asthma population that have carpeting or rugs in the bedroom. All State/National NAS
Percent of asthma population that use mattress covers made for controlling
dust mites.		 All State/National NAS
Percent of asthma population that use pillow covers made for controlling dust
mites.		 All State/National NAS
Percent of asthma population with indoor pets. All State/National NAS
Percent of asthma population that allows pets in the bedroom. All State/National NAS
Percent of asthma population that washes sheets and pillowcases in hot
water.		 All State/National NAS
Behavior—smoking Percent of asthma population that has smoked at least 100 cigarettes in their
entire life.		 All State/National NAS
Percent of asthma population that now smokes every day, some days or not a
all.		 All State/National NAS
Daily Symptom
Burden (Outcome)		 Activity limitation days Number of days unable to work or carry out usual activities due to asthma in the past 12 months. All State/National NAS
Adults State/National BRFSS
Number of school/work days missed. All State/National NAS
Average number of days lost at work or school in the past 30 days. All National HRSA
Average number of missed school days in the past two months. Children National NICHQ
Percent of asthma population that experiences limitation in usual activities due to asthma. All State/National NAS
Symptom—frequency Percent of people with asthma who have had an episode of asthma or an asthma attack during the past 12 months. All State/National NAS
Adults State/National BRFSS
All National MEPS
All National NHIS
Number of days with symptoms of asthma in the past 30 days. All State/National NAS
Adults State/National BRFSS
Number of asthma attacks in the past 3 months. All State/National NAS
Percent of people with asthma who have symptoms all the time. All State/National NAS
Time since last had symptoms of asthma. All State/National NAS
Symptom—duration Duration of most recent asthma attack. All State/National NAS
Percent of people with asthma who had a longer/shorter recent attack compared to last attack. All State/National NAS
Symptom—free Number of symptom-free days in the past two weeks. All State/National NAS
All National HRSA
Number of symptom-free days among patients with persistent asthma. Children National NICHQ
Symptom—sleep Number of days when symptoms of asthma make it difficult to stay asleep in
the past 30 days.		 All State/National NAS
Adults State/National BRFSS
Avoidable Events Emergency/Urgent care

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

 All State/National NAS
Adults State/National BRFSS
Percent of children with asthma who have had an acute asthma visit in the past two months. Children National NICHQ
Return to hospital with same asthma diagnosis within 7 days following emergency department visit or observation stay. Children Hospitals JCAHO-ORYX
Percent of asthma patients who have had a visit to an ED/Urgent care office for asthma in the past 6 months. Children National NICHQ
All National HRSA
All National HRSA
Number of emergency department visits in the past 12 months. All State/National NAS
Adults State/National BRFSS
Hospitalizations Return to hospital with same asthma diagnosis within 7 days following inpatient discharge. Children Hospitals JCAHO-ORYX
Return to hospital with same asthma diagnosis with 30 days following inpatient discharge. Children Hospitals JCAHO-ORYX
Return to hospital with same asthma diagnosis within 30 days following emergency department visit or observation stay. Children Hospitals JCAHO-ORYX
Average length of stay for discharges from short-stay hospitals for asthma. All National NHDS
Risk-adjusted length of stay (LOS) for childhood asthma patients. Children Hospitals JCAHO-ORYX
Have stayed overnight in a hospital due to asthma in the past 12 months. All State/National NAS
Hospital admissions for asthma per 100,000 population. Children State/National HCUP
Adults State/National HCUP
Percent of children with asthma who have had a hospitalization for asthma in the past six months. Children National NICHQ
Rate of discharge from short-stay hospitals for asthma. All National NHDS
Other Dimensions
(Prevalence)		 Prevalence—lifetime

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

 Children State/National BRFSS
Adults State/National BRFSS
All State/National NAS
All National MEPS
All National NHIS
Age at diagnosis. Adults State/National BRFSS
Prevalence—current Percent of people that has ever been told they have asthma by a doctor or health professional that still have asthma. Children State/National BRFSS
Adults State/National BRFSS
All State/National NAS
Prevalence—registry Number of asthma patients in the registry. Children National NICHQ
All National HRSA
Prevalence—family
history		   All State/National NAS
  All State/National NAS
  All State/National NAS
Other Dimensions
(Demographic)		 Demographics Highest level of school completed. All State/National NAS
Zip code. All State/National NAS
Total combined income in household. All State/National NAS
Height. All State/National NAS
Weight. All State/National NAS
Birth weight. All State/National NAS
Percent of asthma population with low birth weight. All State/National NAS
Percent of asthma population of Hispanic or Latino origin. All State/National NAS
Percent of asthma population that is white, black, American Indian/Alaska Native, or Asian/Pacific Islander. All State/National NAS
Percent of asthma population whose household has been without telephone service for 1 week or more in the past 12 months. All State/National NAS
Access Percent 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.		 All State/National NAS
Percent of people with asthma that did not have any health insurance or
coverage. 		All State/National NAS
Employment Percent of asthma population that is currently employed/unemployed. All State/National NAS
Percent of asthma population unable to work for health reasons/disabled. All State/National NAS

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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