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  • Measure Summary
  • NQMC:008024
  • Jul 2012

Diagnosis and management of asthma: percentage of patients with an emergency department visit or inpatient admission for an asthma exacerbation who are discharged from the emergency department or inpatient setting with an asthma discharge plan.

Sveum R, Bergstrom J, Brottman G, Hanson M, Heiman M, Johns K, Malkiewicz J, Manney S, Moyer L, Myers C, Myers N, O’Brien M, Rethwill M, Schaefer K, Uden D. Diagnosis and management of asthma. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jul. 86 p. [81 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

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 patients age five years and older with an emergency department visit or inpatient admission for an asthma exacerbation who are discharged from the emergency department or inpatient setting with an asthma discharge plan.

Rationale

The priority aim addressed by this measure is to increase the rate of patients five years and older who have appropriate treatment and management of asthma in inpatient care settings.

Asthma remains the number one chronic disease of childhood with 12.8 million school days missed. The toll of asthma includes 1.7 million emergency department visits, 10.6 million physician office visits, 444,000 hospitalizations and 3,613 deaths.

The United States has seen declining asthma death rates despite increased prevalence. Fewer patients who have asthma report limitation to activities. Twenty-three million Americans, one out of every 13 people, have this chronic inflammatory lung disease that if uncontrolled can lead to suffering with cough, wheezing and shortness of breath. Approximately 50% of asthma patients report having had an attack within one year, and they suffer a larger volume of missed school and work. Of all asthma patients, more than 13% suffer asthma attacks that require urgent medical care. The Centers for Disease Control and Prevention identified its priority to be patients improving management of asthma symptoms.

Evidence for Rationale

Centers for Disease Control and Prevention (CDC). Hepatitis C virus infection among adolescents and young adults: Massachusetts, 2002-2009. MMWR Morb Mortal Wkly Rep. 2011 May 6;60(17):537-41. PubMed External Web Site Policy

National Asthma Control Initiative. Take action: stop asthma today! What you can do, NOW. NIH publication 10-7542. Bethesda (MD): National Institutes of Health (NIH); 2010 Sep.

Sveum R, Bergstrom J, Brottman G, Hanson M, Heiman M, Johns K, Malkiewicz J, Manney S, Moyer L, Myers C, Myers N, O’Brien M, Rethwill M, Schaefer K, Uden D. Diagnosis and management of asthma. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jul. 86 p. [81 references]

Primary Health Components

Asthma; exacerbation; emergency care; discharge plan; children

Denominator Description

Number of asthma patients who were seen in emergency department or hospitalized for asthma treatment (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of asthma patients who have asthma discharge plan

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Emergency Department

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 5 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

The time frame pertaining to data collection is monthly for those that want to be able to track process changes over a shorter period. Otherwise, data can also be collected quarterly.

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of asthma patients who were seen in emergency department or hospitalized for asthma treatment

Asthma includes International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes 493.00, 493.01, 493.10, 493.11, 493.90, 493.91.

Population Definition: Patients five years and older.

Data Collection: Identify patients with an asthma ICD-9 diagnosis who were seen in emergency department or hospitalized for asthma treatment. If a patient had multiple emergency department or hospital visits during the target month/quarter, select the last emergency department or hospital visit for asthma.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of asthma patients who have asthma discharge plan

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

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

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Percentage of patients with an emergency department visit or inpatient admission for an asthma exacerbation who are discharged from the emergency department OR inpatient setting with an asthma discharge plan.

Measure Collection Name

Diagnosis and Management of Asthma

Submitter

Institute for Clinical Systems Improvement - Nonprofit Organization

Developer

Institute for Clinical Systems Improvement - Nonprofit Organization

Funding Source(s)

The Institute for Clinical Systems Improvement's (ICSI's) work is funded by the annual dues of the member medical groups and five sponsoring health plans in Minnesota and Wisconsin.

Composition of the Group that Developed the Measure

Work Group Members: Richard Sveum, MD (Work Group Leader) (Park Nicollet Health Services) (Allergy); Ken Johns, MD (Allina Medical Clinic) (Pediatrics and Allergy); Sarah Manney, DO (Essentia Health) (Pediatrics); James Bergstrom, MD (Fairview Health Services) (Internal Medicine and Pediatrics); Janet Malkiewicz, RN, AE-C (HealthPartners Medical Group and Regions Hospital) (Health Education); Lisbeth Ann Moyer, RPh (HealthPartners Medical Group and Regions Hospital) (Clinical Pharmacy, Medication Therapy Management); Michael Rethwill, MD (HealthPartners Medical Group and Regions Hospital) (Family Medicine); Gail Brottman, MD (Hennepin Faculty Associates) (Pediatrics); Marlis O'Brien, RRT, CPFT, AE-C (Mayo Clinic) (Respiratory Therapist/Asthma Educator); Mary Heiman, LSN, RN, MS (Minneapolis Public Schools) (School Nurse); Nicolette Myers, MD (Park Nicollet Health Services) (Pulmonology); Kathryn Schaefer, MD (South Lake Pediatrics) (Pediatrics); Donald Uden, PharmD, FCCP (University of Minnesota, School of Pharmacy) (Department of Pharmaceutical Care and Health Systems); Myounghee Hanson, BA (Institute for Clinical Systems Improvement) (Clinical Systems Improvement Facilitator); Cassie Myers (Institute for Clinical Systems Improvement) (Systems Improvement Coordinator)

Financial Disclosures/Other Potential Conflicts of Interest

James Bergstrom, MD, Work Group Member
Internal Medicine and Pediatrics, Fairview Health Services
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Gail Brottman, MD, Work Group Member
Pediatric Medicine, Hennepin Faculty Associates
National, Regional, Local Committee Affiliations: Board member, American Lung Association — MN; Member, American Lung Association National Assembly
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Mary Heiman, LSN, RN, MS, Work Group Member
Minneapolis Public Schools
National, Regional, Local Committee Affiliations: Medica Public Programs steering group member on MN child/family public assistance programs; Board member, School Nurse Organization of MN; School Nurse Organization of MN annual conference reimbursement; Member, U of MN School of Nursing, Children with Special Health Care Needs advisory council
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Ken Johns, MD, Work Group Member
Pediatrician and Allergist, Allina
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Janet Malkiewicz, RN, BSN, AE-C, Work Group Member
Respiratory Nurse Clinician, Health Education, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Sarah Manney, DO, FAAP, Work Group Member
Pediatrician, Essentia Health
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Lisbeth Ann Moyer, RPh, Work Group Member
Clinical Pharmacist, Medication Therapy Management, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Nicolette Myers, MD, Work Group Member
Pulmonologist, Park Nicollet
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Marlis O'Brien, RRT, AE-C, CPFT, Work Group Member
Respiratory Therapist, Mayo Clinic
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Michael Rethwill, MD, Work Group Member
Family Medicine, HealthPartners Medical Group and Regions Hospital
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Kathryn Schaefer, MD, Work Group Member
Pediatrician, South Lake Pediatrics
National, Regional, Local Committee Affiliations: None
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Richard Sveum, MD, Work Group Leader
Allergist, Park Nicollet Health Services
National, Regional, Local Committee Affiliations: Board member, American Lung Association of the Upper Midwest
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: None

Donald Uden, PharmD, FCCP, Work Group Member
Department of Pharmaceutical Care and Health Systems, University of MN
National, Regional, Local Committee Affiliations: Board member, American Lung Association — MN Leadership Board
Guideline-Related Activities: None
Research Grants: None
Financial/Non-Financial Conflicts of Interest: Consultant, Point of Care Decision Support on Asthma guidelines software support; Educational presentation for American Lung Association on "Asthma Medications" given in January 2012

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2012 Jul

Measure Maintenance

Scientific documents are revised every 12 to 24 months as indicated by changes in clinical practice and literature.

Date of Next Anticipated Revision

The next scheduled revision will occur within 24 months.

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)

Sveum R, Bergstrom J, Brottman G, Hanson M, Heiman M, Johns K, Malkiewicz J, Manney S, Moyer L, Myers C, Myers N, O’Brien M, Rethwill M, Schaefer K, Uden D. Diagnosis and management of asthma. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jul. 86 p. [81 references]

Measure Availability

Source available from the Institute for Clinical Systems Improvement (ICSI) Web site External Web Site Policy.

For more information, contact ICSI at 8009 34th Avenue South, Suite 1200, Bloomington, MN 55425; Phone: 952-814-7060; Fax: 952-858-9675; Web site: www.icsi.org External Web Site Policy; E-mail: icsi.info@icsi.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on February 15, 2013.

The information was reaffirmed by the measure developer on January 13, 2016.

Copyright Statement

This NQMC summary (abstracted Institute for Clinical Systems Improvement [ICSI] Measure) is based on the original measure, which is subject to the measure developer's copyright restrictions.

The abstracted ICSI Measures contained in this Web site may be downloaded by any individual or organization. If the abstracted ICSI Measures are downloaded by an individual, the individual may not distribute copies to third parties.

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