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  • Measure Summary
  • NQMC:010412
  • Jan 2015

Asthma care: percentage of pediatric and adult patients who have been educated about his or her asthma and self-management of the condition and also has a written asthma management plan present.

MN Community Measurement. Data collection guide: optimal asthma control 2015. Asthma education and self-management 2015 (07/01/2014 to 06/30/2015 dates of service). Minneapolis (MN): MN Community Measurement; 2015. 58 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of pediatric and adult patients who have been educated about his or her asthma and self-management of the condition and also has a written asthma management plan present.

Rationale

Roughly 7% of adults and children in Minnesota are currently living with asthma. Asthma is a chronic disease associated with familial, infectious, allergenic, socioeconomic, psychosocial and environmental factors. It is not curable but is treatable. Despite improvements in diagnosis and management, and an increased understanding of the epidemiology, immunology, and biology of the disease, asthma prevalence has progressively increased over the past 15 years. It is up to providers to assess patients, prescribe medications, educate about self-management, help patients identify and mitigate triggers so patients can prevent their exacerbations.

Evidence for Rationale

MN Community Measurement. Data collection guide: optimal asthma control 2015. Asthma education and self-management 2015 (07/01/2014 to 06/30/2015 dates of service). Minneapolis (MN): MN Community Measurement; 2015. 58 p.

Primary Health Components

Asthma; patient education; management plan; children

Denominator Description

Patients who meet each of the following criteria are included in the population:

  • Patient was age 5 to 50 years at the start of the measurement period.
  • Patient was seen by an eligible provider in an eligible specialty face-to-face visit at least two times during the last two measurement periods with visits coded with an asthma International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code (in any position, not only primary).
  • Patient was seen by an eligible provider in an eligible specialty face-to-face visit at least one time during the measurement period for any reason. This may or may not include a face-to-face visit with an asthma ICD-9 code.
  • Diagnosis of asthma.

See the related "Denominator Inclusions/Exclusion" field.

Numerator Description

Patient has been educated about his or her asthma and self-management of the condition and also has a written asthma management plan present (created or reviewed and revised within the measurement period) (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

  • Prevalence with Adults: The Asthma in Minnesota 2008 Epidemiology Report published by the Minnesota Department of Health noted that in 2007:
    • 10.9% of adults in Minnesota reported that they had been told sometime in their lifetime that they had asthma; 7.7% reported that they still had asthma.
    • That translates to an estimated 429,000 Minnesota adults who have a history of asthma and an estimated 303,000 who currently have asthma (Minnesota Department of Health, n.d.).
  • Prevalence with Children: In 2006, the Minnesota Behavioral Risk Surveillance System (BRFSS) reported that:
    • 9.5% of children (age 0 to 17) in Minnesota have been diagnosed with asthma, and 7% were reported to currently have asthma.
    • That translates to an estimated 116,000 Minnesota children with a history of asthma and an estimated 85,000 who currently have asthma. The prevalence of asthma among children has remained stable since 2003 (Centers for Disease Control and Prevention [CDC], n.d.).
  • Prevalence Nationally: An estimated 22.2 million adults and 6.5 million children currently have asthma in the United States.
  • Minnesota Costs: The total costs for asthma in Minnesota for 2003 were estimated at $363.9 million, including $208.6 million in direct costs of office visits, emergency department (ED) visits, hospitalizations and medication, and $155.3 million in indirect costs of missed school and work days (Coffey et al., 2006).
  • National Costs: In 2004, the economic costs of asthma for the United States were estimated at more than $16 billion. This figure included $4.6 billion in lost productivity. Updated estimates for direct medical expenditures alone in 2007 were $37.2 billion (Kamble & Bharmal, 2009). The societal costs of asthma are acutely felt in the pediatric population with asthma cited as the most frequent cause of pediatric emergency room use and hospital admissions as well as the leading cause of school absences.

Evidence for Additional Information Supporting Need for the Measure

Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System. [internet]. Atlanta (GA): Centers for Disease Control and Prevention (CDC); [2].

Coffey RM, Ho K, Adamson DM, Matthews TL, Sewell J. Asthma care quality improvement: a resource guide for state action (prepared by Thomson Medstat and The Council of State Governments under contract No. 290-00-0004). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services (DHHS); 2006 Apr. 143 p.  (AHRQ publication; no. 06-0012-1).

Kamble S, Bharmal M. Incremental direct expenditure of treating asthma in the United States. J Asthma. 2009 Feb;46(1):73-80. PubMed External Web Site Policy

Minnesota Department of Health. Asthma research and data. [internet]. Minneapolis (MN): MN Community Measurement; [2].

MN Community Measurement. Data collection guide: optimal asthma control 2015. Asthma education and self-management 2015 (07/01/2014 to 06/30/2015 dates of service). Minneapolis (MN): MN Community Measurement; 2015. 58 p.

Extent of Measure Testing

MN Community Measurement (MNCM) conducts validity testing to determine if quality measures truly measure what they are designed to measure, and conducts reliability testing to determine if measures yield stable, consistent results. Validity testing is done to see if the concept behind the measure reflects the quality of care that is provided to a patient and if the measure, as specified, accurately assesses the intended quality concept. Reliability testing is done to see if calculated performance scores are reproducible.

Evidence for Extent of Measure Testing

MN Community Measurement. Measure testing. [internet]. Minneapolis (MN): MN Community Measurement; [accessed 2015 Nov 12].

State of Use

Current routine use

Current Use

Care coordination

External oversight/State government program

Internal quality improvement

Pay-for-performance

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Hospital Outpatient

Transition

Type of Care Coordination

Coordination between providers and patient/caregiver

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age 5 to 50 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Effective Communication and Care Coordination
Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

Measurement period will be a fixed 12-month period: July 1 to June 30

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window brackets index event

Denominator Inclusions/Exclusions

Inclusions
Patients who meet each of the following criteria are included in the population:

  • Patient was age 5 to 50 at the start of the measurement period.
    • Age 5 to 17 at the start of the measurement period.
    • Age 18 to 50 at the start of the measurement period.
  • Patient was seen by an eligible provider in an eligible specialty face-to-face visit at least two times during the last two measurement periods with visits coded with an asthma International Classification of Diseases, Ninth Revision (ICD-9) code (in any position, not only primary).
  • Patient was seen by an eligible provider in an eligible specialty face-to-face visit at least one time during the measurement period for any reason. This may or may not include a face-to-face visit with an asthma ICD-9 code.
  • Diagnosis of asthma. Refer to Table 1 in the original measure documentation for ICD-9 diagnosis codes for identifying asthma.

Exclusions

  • Patient was a permanent nursing home resident during the measurement period.
  • Patient was in hospice at any time during the measurement period.
  • Patient died prior to the end of the measurement period.
  • Documentation that diagnosis was coded in error.
  • Patient was coded with any of the following diagnoses (refer to Table 2 in the original measure documentation for ICD-9 diagnosis codes for identifying patients meeting exclusion criteria):
    • Cystic fibrosis
    • Chronic obstructive pulmonary disease (COPD)
    • Emphysema
    • Acute respiratory failure

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patient has been educated about his or her asthma and self-management of the condition and also has a written asthma management plan present (created or reviewed and revised within the measurement period):

Patient has a written asthma management plan in the chart with the following documented:

  • Plan contains information on medication doses and purposes of these medications.
  • Plan contains information on how to recognize and what to do during an exacerbation.
  • Plan contains information on the patient's triggers.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

2015 Optimal Asthma Control Measure Flow Chart

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Analysis by subgroup (stratification by individual factors, geographic factors, etc.)

Description of Allowance for Patient or Population Factors

This measure is stratified by the following age groups:

  • Pediatric patients age 5 to 17
  • Adult patients age 18 to 50

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Asthma education & self-management 2015.

Measure Collection Name

Optimal Asthma Care

Submitter

MN Community Measurement - Health Care Quality Collaboration

Developer

MN Community Measurement - Health Care Quality Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

The Optimal Asthma Care measure was developed using a technical advisory workgroup and multi-stakeholder process.

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2015 Jan

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

MN Community Measurement. Data collection guide: optimal asthma control 2015. Asthma education and self-management 2015 (07/01/2014 to 06/30/2015 dates of service). Minneapolis (MN): MN Community Measurement; 2015. 58 p.

Measure Availability

Source available from the MN Community Measurement Web site External Web Site Policy.

For more information, contact MN Community Measurement at 3433 Broadway St. NE, Broadway Place East, Suite #455, Minneapolis, MN 55413; Phone: 612-455-2911; Web site: http://mncm.org External Web Site Policy; E-mail: info@mncm.org.

Companion Documents

The following is available:

  • Snowden AM, Mlodzik R, Ghere E. 2014 health care quality report. Minneapolis (MN): MN Community Measurement; 2014 Dec. 335 p. This document is available from the MN Community Measurement Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on December 4, 2015. The information was verified by the measure developer on February 16, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

This measure is subject to review and may be revised or rescinded at any time by MN Community Measurement (MNCM). The measure may not be altered without the prior written approval of MNCM. Measures developed by MNCM, while copyrighted, can be reproduced and distributed without modification for noncommercial purposes (e.g., use by health care providers in connection with their practices). Commercial use is defined as the sale, license, or distribution of the measure for commercial gain, or incorporation of the measure into a product of service that is sold, licensed or distributed for commercial gain. Commercial use of the measure requires a license agreement between the user and MNCM.

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