Use of Appropriate Medications for Asthma
Percentage of patients 5-64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.
National Committee for Quality Assurance
National Committee for Quality Assurance
National Quality Forum
Finalized Date/Time
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Report a total score, and each of the following strata:
Stratum 1: Patients age 5-11
Stratum 2: Patients age 12-18
Stratum 3: Patients age 19-50
Stratum 4: Patients age 51-64
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Asthma is one of the most prevalent chronic diseases, becoming increasingly more commonplace over the past twenty years. Approximately 24.6 million Americans have asthma, and it is responsible for over 3,000 deaths in the U.S. annually (American Lung Association 2010). In 2006, 13.3 million clinical visits (hospital, outpatient, emergency department, and physician offices) were attributed to asthma (Centers for Disease Control and Prevention 2009). The incidence rate, and subsequently the number of asthma-related health visits, is expected to increase by an additional 100 million globally by 2025 (World Health Organization 2007).
Asthma accounts for over $20 billion spent on health care in the United States. Direct costs, including prescriptions, make up $15.6 billion of that total. Indirect costs, such as lost productivity, add an additional $5.1 billion (Centers for Disease Control and Prevention 2009). Inpatient hospitalization accounts for over 50 percent of overall asthma-related costs (Bahadori et al. 2009). In addition to the direct financial burden, asthma is also a leading cause of absenteeism and productivity, accounting for an estimated 14.2 million missed workdays for adults and over 14 million missed school days for children (Akinbami et al. 2009). Studies have shown that the indirect costs of asthma are becoming a growing financial burden on patients, and resulting in significant additional costs (Bahadori et al. 2009).
Appropriate medication management could potentially prevent a significant proportion of asthma-related costs (hospitalizations, emergency room visits and missed work and school days) (Akinbami et al. 2009). The Asthma Regional Council supported this inference, stating that proper management could potentially save at least 25 percent of total asthma costs, or $5 billion, nationally by reducing health care costs (American Lung Association 2009).
Another initiative, the Children’s Health Fund’s Childhood Asthma Initiative, examined patients enrolled in an asthma intervention program. Results illustrated that treatment that aligned with clinical guidelines reduced the severity of symptoms experienced, as well as asthma-related events (e.g., hospitalizations, emergency room visits, etc.) (Columbia University 2010). Additionally, subsequent savings attributed to improved clinical outcomes totaled to nearly $4.2 million or $4,525 per patient. This translated to a significant reduction in federally subsidized and private insurance-based costs for this population (Columbia University 2010).
National Heart Lung and Blood Institute/National Asthma and Education Prevention Program (2007)
• Long-term control medications (include inhaled corticosteroids (ICSs), inhaled long-acting bronchodilators, leukotriene modifiers, cromolyn, theophylline, and immunomodulators) are used daily to achieve and maintain control of persistent asthma. The most effective are those that attenuate the underlying inflammation characteristic of asthma. The Expert Panel defines anti-inflammatory medications as those that cause a reduction in the markers of airway inflammation in airway tissue or airway secretions (e.g., eosinophils, mast cells, activated lymphocytes, macrophages, and cytokines; or Eosinophil cationic protein (ECP) and tryptase; or extravascular leakage of albumin, fibrinogen, or other vascular protein).
• Inhaled corticosteroids are the preferred treatment option for mild persistent asthma in adults and children. Leukotriene Receptor Antagonists (LTRAs) are an alternative, although not preferred, treatment.
• Long-acting beta-2 agonists (LABAs) should only be used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children =5 years of age and adults). There is a strong recommendation against the use of LABAs as monotherapy. Of the adjunctive therapies available, long-acting beta-2 agonists is the preferred therapy to combine with ICS in youths =12 years of age and adults.
• The beneficial effects of long-acting beta-2 agonists in combination therapy for the great majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although uncommon, associated with the daily use of long-acting beta-2 agonists (see discussion in text).
• The NHLBI/NAEPP guideline strongly recommends against the use of long-acting beta-2 agonists for the treatment of acute symptoms or exacerbations.
Higher score indicates better quality
NQF ID Number
Disclaimer
These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications.
THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
eMeasure Identifier
126
measureStartDate
measureEndDate
Akinbami, L.J., J.E. Moorman, P.L. Garbe, E.J. Sondik. 2009. “Status of Childhood Asthma, United States, 1980–2007.” Pediatrics 123 (Supplement 3):S131-45.
American Lung Association. 2010. Trends in Asthma Morbidity and Mortality. http://www.lung.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf
Bahadori, K., M.M. Doyle-Waters, C. Marra, L. Lynd, K. Alasaly, J. Swiston, J.M. FitzGerald. 2009. “Economic burden of asthma: a systematic review.” BMC Pulm Med 9(24): 1-16.
Centers for Disease Control and Prevention. 2009. “Asthma: A Presentation of Asthma Management and Prevention.” http://www.cdc.gov/asthma/speakit/default.htm
Columbia University. 2010. “Best Practice Asthma Program Saves the US Healthcare System More than $4500 a Year per Child.” http://www.mailman.columbia.edu/news/best-practice-asthma-program-saves-us-healthcare-system-more-4500-year-child
National Heart Lung and Blood Institute/National Asthma Education and Prevention Program. 2007. Measures of asthma assessment and monitoring: Expert panel report 3: guidelines for the diagnosis and management of asthma. Washington: National Heart Lung and Blood Institute (NHLBI).
World Health Organization. 2007. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. http://www.who.int/gard/publications/GARD_Manual/en/index.html
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Transmission Format
TBD
Initial Patient Population
Patients 5-64 years of age with persistent asthma and a visit during the measurement period
Denominator
Equals Initial Patient Population
Denominator Exclusions
Patients with emphysema, COPD, cystic fibrosis or acute respiratory failure during or prior to the measurement period
Numerator
Patients who were dispensed at least one prescription for a preferred therapy during the measurement period
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.
None
Population criteria
-
Initial Patient Population =
- AND: "Patient Characteristic Birthdate: birth date" >= 5 year(s) starts before start of "Measurement Period"
- AND: "Patient Characteristic Birthdate: birth date" < 64 year(s) starts before start of "Measurement Period"
- AND: "Occurrence A of Diagnosis, Active: Persistent Asthma" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Persistent Asthma" ends before start of "Measurement Period"
- AND:
- OR: "Encounter, Performed: Office Visit"
- OR: "Encounter, Performed: Face-to-Face Interaction"
- OR: "Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17"
- OR: "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up"
- OR: "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up"
- OR: "Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17"
- OR: "Encounter, Performed: Home Healthcare Services"
- during "Measurement Period"
-
Denominator =
- AND: "Initial Patient Population"
-
Denominator Exclusions =
- AND:
- OR:
- AND: "Occurrence A of Diagnosis, Active: Chronic Obstructive Pulmonary Disease" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Chronic Obstructive Pulmonary Disease" ends before start of "Measurement Period"
- OR:
- AND: "Occurrence A of Diagnosis, Active: Emphysema" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Emphysema" ends before start of "Measurement Period"
- OR:
- AND: "Occurrence A of Diagnosis, Active: Cystic Fibrosis" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Cystic Fibrosis" ends before start of "Measurement Period"
- OR:
- AND: "Occurrence A of Diagnosis, Active: Acute Respiratory Failure" starts before or during "Measurement Period"
- AND NOT: "Occurrence A of Diagnosis, Active: Acute Respiratory Failure" ends before start of "Measurement Period"
-
Numerator =
- AND: "Medication, Dispensed: Preferred Asthma Therapy" during "Measurement Period"
-
Denominator Exceptions =
- None
Patient Characteristic Birthdate: birth date
Measurement Period
Patient Characteristic Birthdate: birth date
Measurement Period
Occurrence A of Diagnosis, Active: Persistent Asthma
Measurement Period
Occurrence A of Diagnosis, Active: Persistent Asthma
Measurement Period
Encounter, Performed: Office Visit
Encounter, Performed: Face-to-Face Interaction
Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17
Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up
Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17
Encounter, Performed: Home Healthcare Services
Measurement Period
Initial Patient Population
Initial Patient Population
Occurrence A of Diagnosis, Active: Chronic Obstructive Pulmonary Disease
Measurement Period
Occurrence A of Diagnosis, Active: Chronic Obstructive Pulmonary Disease
Measurement Period
Occurrence A of Diagnosis, Active: Emphysema
Measurement Period
Occurrence A of Diagnosis, Active: Emphysema
Measurement Period
Occurrence A of Diagnosis, Active: Cystic Fibrosis
Measurement Period
Occurrence A of Diagnosis, Active: Cystic Fibrosis
Measurement Period
Occurrence A of Diagnosis, Active: Acute Respiratory Failure
Measurement Period
Occurrence A of Diagnosis, Active: Acute Respiratory Failure
Measurement Period
Denominator
Medication, Dispensed: Preferred Asthma Therapy
Measurement Period
Data criteria (QDM Data Elements)
-
"Diagnosis, Active: Acute Respiratory Failure" using "Acute Respiratory Failure Grouping Value Set (2.16.840.1.113883.3.464.1003.102.12.1018)"
-
"Diagnosis, Active: Chronic Obstructive Pulmonary Disease" using "Chronic Obstructive Pulmonary Disease Grouping Value Set (2.16.840.1.113883.3.464.1003.102.12.1007)"
-
"Diagnosis, Active: Cystic Fibrosis" using "Cystic Fibrosis Grouping Value Set (2.16.840.1.113883.3.464.1003.102.12.1002)"
-
"Diagnosis, Active: Emphysema" using "Emphysema Grouping Value Set (2.16.840.1.113883.3.464.1003.102.12.1004)"
-
"Diagnosis, Active: Persistent Asthma" using "Persistent Asthma Grouping Value Set (2.16.840.1.113883.3.464.1003.102.12.1023)"
-
"Encounter, Performed: Face-to-Face Interaction" using "Face-to-Face Interaction Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1048)"
-
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1016)"
-
"Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1001)"
-
"Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17" using "Preventive Care - Established Office Visit, 0 to 17 Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1024)"
-
"Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" using "Preventive Care Services - Established Office Visit, 18 and Up Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1025)"
-
"Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" using "Preventive Care Services-Initial Office Visit, 18 and Up Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1023)"
-
"Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17" using "Preventive Care- Initial Office Visit, 0 to 17 Grouping Value Set (2.16.840.1.113883.3.464.1003.101.12.1022)"
-
"Medication, Dispensed: Preferred Asthma Therapy" using "Preferred Asthma Therapy Grouping Value Set (2.16.840.1.113883.3.464.1003.196.12.1212)"
-
"Patient Characteristic Birthdate: birth date" using "birth date LOINC Value Set (2.16.840.1.113883.3.560.100.4)"
Patient Characteristic Birthdate: birth date
Medication, Dispensed: Preferred Asthma Therapy
Encounter, Performed: Office Visit
Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up
Encounter, Performed: Face-to-Face Interaction
Encounter, Performed: Home Healthcare Services
Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17
Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17
Persistent Asthma
Chronic Obstructive Pulmonary Disease
Emphysema
Cystic Fibrosis
Acute Respiratory Failure
Diagnosis, Active: Persistent Asthma
Diagnosis, Active: Chronic Obstructive Pulmonary Disease
Diagnosis, Active: Emphysema
Diagnosis, Active: Cystic Fibrosis
Diagnosis, Active: Acute Respiratory Failure
Reporting Stratification
-
Reporting Stratum 1 =
- AND: "Patient Characteristic Birthdate: birth date" >= 5 year(s) starts before start of "Measurement Period"
- AND: "Patient Characteristic Birthdate: birth date" <= 11 year(s) starts before start of "Measurement Period"
-
Reporting Stratum 2 =
- AND: "Patient Characteristic Birthdate: birth date" >= 12 year(s) starts before start of "Measurement Period"
- AND: "Patient Characteristic Birthdate: birth date" <= 18 year(s) starts before start of "Measurement Period"
-
Reporting Stratum 3 =
- AND: "Patient Characteristic Birthdate: birth date" >= 19 year(s) starts before start of "Measurement Period"
- AND: "Patient Characteristic Birthdate: birth date" <= 50 year(s) starts before start of "Measurement Period"
-
Reporting Stratum 4 =
- AND: "Patient Characteristic Birthdate: birth date" >= 51 year(s) starts before start of "Measurement Period"
- AND: "Patient Characteristic Birthdate: birth date" < 64 year(s) starts before start of "Measurement Period"
Stratum
Patient Characteristic Birthdate: birth date
Measurement Period
Patient Characteristic Birthdate: birth date
Measurement Period
Stratum
Patient Characteristic Birthdate: birth date
Measurement Period
Patient Characteristic Birthdate: birth date
Measurement Period
Stratum
Patient Characteristic Birthdate: birth date
Measurement Period
Patient Characteristic Birthdate: birth date
Measurement Period
Stratum
Patient Characteristic Birthdate: birth date
Measurement Period
Patient Characteristic Birthdate: birth date
Measurement Period
Supplemental Data Elements
-
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDCREC Value Set (2.16.840.1.114222.4.11.837)"
-
"Patient Characteristic Payer: Payer" using "Payer SOP Value Set (2.16.840.1.114222.4.11.3591)"
-
"Patient Characteristic Race: Race" using "Race CDCREC Value Set (2.16.840.1.114222.4.11.836)"
-
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex AdministrativeSex Value Set (2.16.840.1.113762.1.4.1)"
Patient Characteristic Ethnicity: Ethnicity
Patient Characteristic Sex: ONC Administrative Sex
Patient Characteristic Payer: Payer
Patient Characteristic Race: Race