| 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. |
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