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  • Measure Summary
  • NQMC:009940
  • Nov 2014

Use of appropriate medications for people with asthma: percentage of patients 5 to 64 years of age during the measurement year who were identified as having persistent asthma and who were appropriately dispensed medication during the measurement year.

National Committee for Quality Assurance (NCQA). HEDIS 2015 technical specifications for ACO measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

This is the current release of the measure.

This measure updates a previous version: National Committee for Quality Assurance (NCQA). HEDIS 2013 Technical Specifications for ACO Measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2012. various p.

The measure developer reaffirmed the currency of this measure in November 2015.

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 5 to 64 years of age during the measurement year who were identified as having persistent asthma and who were appropriately dispensed medication during the measurement year.

Note from the National Quality Measures Clearinghouse (NQMC): For this measure, there are both Electronic and Hybrid Specifications. This NQMC measure summary is based on the Electronic specification. Refer to the original measure documentation for details pertaining to the Hybrid specification.

Rationale

Asthma is the most common chronic childhood disease, affecting an estimated 5 million children. Overall, approximately 20 million people in the United States (U.S.) have asthma (National Institutes of Health [NIH] & National Heart, Lung and Blood Institute [NHLBI], 2003). Collectively, people with asthma have more than 100 million days of restricted activity and 5,000 deaths annually. Much of the death and morbidity associated with asthma is avoidable. Successful management of asthma can be achieved for most asthmatics if they take medication that provide long-term control.

Asthma-related suffering, cost and death can be greatly reduced through effective treatment with long-term controller medications. In addition, patient education regarding medication use, symptom management and avoidance of asthma attack triggers can greatly reduce the impact of the disease.

This process measure evaluates whether members 5 to 64 years of age with persistent asthma are being prescribed medications acceptable as primary therapy for long-term asthma control. The list of acceptable medications is derived from the NHLBI's National Asthma Education Prevention Program (NAEPP) guidelines (NAEPP, 1997).

Evidence for Rationale

National Asthma Education and Prevention Program (NAEPP). NAEPP expert panel report 2: guidelines for the diagnosis and management of asthma. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung and Blood Institute; 1997 Jul. 146 p.

National Committee for Quality Assurance (NCQA). HEDIS 2015: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

National Institutes of Health, National Heart, Lung and Blood Institute. Frequently asked questions-asthma statistics. [internet]. Bethesda (MD): U.S. Department of Health and Human Services; 2003. 

Primary Health Components

Persistent asthma; asthma controller medications

Denominator Description

Patients age 5 to 64 years by December 31 of the measurement year who were identified as having persistent asthma (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Evidence of at least one asthma medication for a preferred therapy during the measurement year (see the related "Numerator Inclusions/Exclusions" field)

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

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

All HEDIS measures undergo systematic assessment of face validity with review by measurement advisory panels, expert panels, a formal public comment process and approval by the National Committee for Quality Assurance's (NCQA) Committee on Performance Measurement and Board of Directors. Once NCQA establishes national benchmarks for accountable care organization (ACO) performance, all measures will undergo formal reliability testing of the performance measure score using beta-binomiol statistical analysis. Where applicable, measures also are assessed for construct validity using the Pearson correlation test.

Evidence for Extent of Measure Testing

Rehm B. (Assistant Vice President, Performance Measurement, National Committee for Quality Assurance, Washington, DC). Personal communication. 2015 Apr 8.  1 p.

State of Use

Current routine use

Current Use

Accreditation

Collaborative inter-organizational quality improvement

Decision-making by consumers about health plan/provider choice

Decision-making by health plans about provider contracting

Internal quality improvement

Pay-for-performance

Public reporting

Measurement Setting

Accountable Care Organizations

Ambulatory/Office-based Care

Emergency Department

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Pharmacists

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Multisite Health Care or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age 5 to 64 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 measurement year and the year prior to the measurement year

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Institutionalization

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Time window brackets index event

Denominator Inclusions/Exclusions

Inclusions
Patients age 5 to 64 years by December 31 of the measurement year who were identified as having persistent asthma

Note:

  • Identify patients as having persistent asthma who met at least one of the following criteria during both the measurement year and the year prior to the measurement year. Criteria need not be the same across both years.
    • At least one emergency department (ED) visit (ED Value Set) with a principal diagnosis of asthma (Asthma Value Set)
    • At least one acute inpatient encounter (Acute Inpatient Value Set) with a principal diagnosis of asthma (Asthma Value Set)
    • At least four outpatient asthma visits (Outpatient Value Set) or observation visits (Observation Value Set) on different dates of service with any diagnosis of asthma (Asthma Value Set) and at least two asthma medication dispensing events (refer to Table ASM-C in the original measure documentation for a list of asthma medications). Visit type need not be the same for the four visits.
    • At least four asthma medication dispensing events (refer to Table ASM-C in the original measure documentation for a list of asthma medications).
  • A patient identified as having persistent asthma because of at least four asthma medication dispensing events, where leukotriene modifiers or antibody inhibitors were the sole asthma medication dispensed in that year, must also have at least one diagnosis of asthma (Asthma Value Set) during the same year as the leukotriene modifier or antibody inhibitor.

Refer to the original measure documentation for steps to identify the eligible population.

Exclusions
Exclude patients who had any diagnosis from any of the following value sets, any time during the patient's history through December 31 of the measurement year:

  • Emphysema Value Set
  • Other Emphysema Value Set
  • Chronic Obstructive Pulmonary Disease (COPD) Value Set
  • Obstructive Chronic Bronchitis Value Set
  • Chronic Respiratory Conditions Due To Fumes/Vapors Value Set
  • Cystic Fibrosis Value Set
  • Acute Respiratory Failure Value Set

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS 2015 Technical Specifications for ACO Measurement, which includes the Value Set Directory.

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Evidence of at least one asthma medication for a preferred therapy during the measurement year (refer to table AASM-E in the original measure documentation for a list of asthma controller medications)

Note:

  • Oral Medication Event: One medication lasting 30 days or less. To calculate events for prescriptions longer than 30 days, divide the days supply by 30 and round down to convert.
    • Pharmacy Data: Dispensing events. Allocate the dispensing events to the appropriate year based on the date when the prescription is filled.
    • Prescription Data: Prescribing events. Allocate the prescribing events to the appropriate year based on prescription date and the days supply.
  • Multiple Medications on the Same Day: Assess multiple medications on the same day separately. If multiple prescriptions for the same medication are written on the same day, sum the days supply and divide by 30. Use the Drug ID in the NDC list to determine if the medications are the same or different.
  • Inhaler Dispensing Event: All inhalers (i.e., canisters) of the same medication dispensed or prescribed on the same day count as one dispensing event. Medications with different Drug IDs dispensed on the same day are counted as different dispensing events. Allocate the dispensing events to the appropriate year based on the date when the prescription was filled.
  • Injection Dispensing Event: Each injection counts as one dispensing event. Multiple dispensed or prescribed injections of the same or different medications count as separate dispensing events. Allocate the dispensing events to the appropriate year based on the date when the prescription was filled.

Refer to the original measure documentation for additional details.

Exclusions
Unspecified

Value Set Information
Measure specifications reference value sets that must be used for HEDIS reporting. A value set is the complete set of codes used to identify the service(s) or condition(s) included in the measure. Refer to the NCQA Web site External Web Site Policy to purchase HEDIS 2015 Technical Specifications for ACO Measurement, which includes the Value Set Directory.

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Pharmacy data

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

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

Description of Allowance for Patient or Population Factors

The Accountable Care Organization (ACO) aggregate population is reported as a whole, with an option to report Medicaid separately for measures for which HEDIS Health Plan Measurement offers Medicaid specifications.

This measure includes four age stratifications (based on age as of December 31 of the measurement year) and a total rate:

  • 5 to 11 years
  • 12 to 18 years
  • 19 to 50 years
  • 51 to 64 years
  • Total

The total is the sum of the four age stratifications.

Standard of Comparison

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

External comparison of time trends

Internal time comparison

Original Title

Use of appropriate medications for people with asthma (AASM).

Measure Collection Name

HEDIS 2015: Accountable Care Organization (ACO) Collection

Measure Set Name

Effectiveness of Care

Measure Subset Name

Respiratory Conditions

Submitter

National Committee for Quality Assurance - Health Care Accreditation Organization

Developer

National Committee for Quality Assurance - Health Care Accreditation Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.

Financial Disclosures/Other Potential Conflicts of Interest

In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.

Core Quality Measures

Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care

Adaptation

This measure was adapted from the HEDIS Technical Specifications for Health Plans ("HEDIS Health Plan Measurement") and HEDIS Physician Measurement.

Date of Most Current Version in NQMC

2014 Nov

Measure Maintenance

Annual

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: National Committee for Quality Assurance (NCQA). HEDIS 2013 Technical Specifications for ACO Measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2012. various p.

The measure developer reaffirmed the currency of this measure in November 2015.

Source(s)

National Committee for Quality Assurance (NCQA). HEDIS 2015 technical specifications for ACO measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2014. various p.

Measure Availability

Source available for purchase from the National Committee for Quality Measurement (NCQA) Web site External Web Site Policy.

For more information, contact NCQA at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Phone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 13, 2014.

This NQMC summary was updated by ECRI Institute on February 11, 2015.

The information was reaffirmed by the measure developer on November 2, 2015.

Copyright Statement

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

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