| REQUIRED MEASURES |
Measure
|
Definition
|
Data Gathering Plan
|
Goal
|
Notes/Comments |
| 1.Current severity assessment |
The # of patients with a severity assessment at last contact
(visit or phone) within the past 12 months divided by the # of patients in the registry.
Multiply by 100 to get percent. |
On the last workday of each month from the registry: count
the # of patients with severity assessment at last contact within the past 12 months;
count the total # of patients in the registry. |
>90%
|
Ref #1, #2 The meaning of current has two components: the severity assessment was done at the last contact (and so is the most current information we have on the patient) AND the assessment is recent, within the last 12 months. |
| 2.Appropriate treatment with anti-inflammatory medication |
The # of patients with an underlying NHLBI classification
of persistent asthma at last contact who are on anti-inflammatory
medication divided by the # of patients with a NHLBI classification
of persistent asthma. Multiply by 100 to get percent. |
On the last day workday of each month from the registry:
count the # of patients with an underlying severity classification
of persistent asthma at last contact on anti-inflammatory
meds; count the total # of patients with an underlying classification
of persistent asthma at last contact in the registry. |
>95%
|
We need to distinguish underlying severity from current
control severity. There are two different fields in PECS that
track these two different attributes. The persistent severity
in this measure refers to the underlying severity. In early
versions of PECS, underlying severity was referred to as baseline.
Meds include chronically administered inhaled corticosteroids,
mast cell stabilizers and leukotreine inhibitors. Ref # 1
|
| 3.Current self-management goal. |
The number of asthma patients in the registry with documented
self-management goals in the last 12 months divided by the
total number of asthma patients in the registry. Multiply
by 100 to get percentage. |
On the last workday of each month from the registry: count
the # of patients with documented self-management goal in
the last 12 months; count the total # of patients in the registry. |
>70% |
References 12, 13 |
| 4. Number of symptom-free days in previous two weeks. |
At each patient contact, ask the number of days with symptoms
in the previous two weeks. Subtract that number from 14 to
get the number of symptom-free days for the patient in the
previous two weeks. (Sum the symptom-free days over all patients.
Divide the sum by the number of patients in the registry who
report symptom free days.) |
On the last workday of each month, search the registry to
find the patients who had a severity assessment at last contact.
Use the estimate of symptom-free days provided at this contact. |
>10 days
|
Symptoms are: daytime coughing, wheezing, shortness of breath,
chest tightness;, night-time coughing and wheezing.
We define “days” as 24 hour periods—a “day”
covers daytime and nighttime.
The standard care guideline asks about day-time symptoms in
past week and night-time symptoms in the past month.
The flow sheet should contain a specific item that allows
a record of symptoms in previous two weeks. |
| ADDITIONAL RECOMMENDED
MEASURES: These measures are not required; however, you will
find that they can be used to enhance care and increase the
ability to achieve the required measures above. |
Measure
|
Definition
|
Data Gathering Plan
|
Goal
|
Notes/Comments |
| 5.Exposure to environmental tobacco smoke |
The # of patients with a reported exposure to environmental
tobacco smoke at last visit divided by the # of patients with
documented exposure status in the registry. Multiply by 100
to get percent. |
On the last workday of each month, from the registry: count
the # of patients with reported exposure to ETS at last visit;
count the total # of patients in the registry with documented
exposure status. |
<20%
|
References 1,4, 14 |
| 6. Evaluation of environmental triggers |
The # of patients evaluated for environmental triggers other
than ETS (dust mites, cats, dogs, molds/fungi, cockroaches)
either by history of exposure and/or by allergy testing divided
by the # of patients in the registry. Multiply by 100 to get
percent.
|
On the last workday of each month from the registry: count
the # of patients who have been evaluated for the specific
environmental triggers other than ETS; count the total # of
patients in the registry. |
>90%
|
This measure (and the ETS measure) can overlap with the
self-management measure in that a patient and provider can
agree to work to reduce exposure to a trigger as a self-management
goal.
Evaluation may need to be repeated based on changes in clinical
history and control state.
The “indoor” environmental triggers here are those
listed in Reference 4 as having the strongest evidence of
causal relationship to asthma. See also References 2, 3, 14
|
| 7.ED/Urgent Care visits for asthma |
The # of patients who have had a visit to an ED/Urgent Care
office for asthma in the past six months reported at last
contact divided by the # of patients in the registry with
documented query about ED/Urgent Care visits. Multiply by
100 to get percent. |
On the last workday of each month from the registry: count
the # of patients at last contact who have had a visit to
ED/Urgent Care for asthma in the previous six months; count
the total # of patients in the registry with documented query
about ED/Urgent Care visits. |
<5%
|
ED/Urgent Care visits can be counted from patient self-reports
and from reports sent to the clinic by ED or Urgent Care offices.
Nationally, ED/Urgent Care visit Rate for children 0 to 5
is twice the rate of patients 6 to 64. Health centers may
want to look at ED/Urgent care visits for these young children
separately to understand issues and opportunities (.Ref 8).
|
| 8. Average Lost Workdays and/or school days |
At each patient contact, ask the number of days in the past
30 lost at work or school because of asthma. (Sum the lost
days over all patients who report lost work or school days.
Divide the sum by the number of patients in the registry who
have been queried about lost work or school days at last contact.) |
On the last workday of each month from the registry: get
the number of lost days reported at last contact for each
patient. Count the number of patients with documented lost
work or school days at last visit. |
<1 day
|
The documented number of days should include ZERO lost days
as a possibility. We want to know across the population the
average number of lost days, we should not restrict attention
only to the patients who actually lost time. For pre-school
pediatric patients or retired adults, we allow teams to ask
about incapacity to carry out ordinary activities. Ref. 8 |
| 9.Establishment of Personal Best Peak Flow |
The # of patients older than 5 years with an NHLBI classification
of moderate or severe persistent asthma who have established
a “Personal Best” peak flow through multiple measurements
during a period of relative disease stability divided by the
# of patients with a NHLBI classification of moderate or severe
persistent asthma older than five years. Multiply by 100 to
get percent. |
On the last day workday of each month from the registry:
count the # of patients older than five years (with a NHLBI
classification of moderate or severe persistent asthma) who
have established a “Personal Best” peak flow through
multiple measurements during a period of relative disease
stability; count the total # of patients older than five years
with a NHLBI classification of moderate or severe persistent
asthma. |
>80%
|
Multiple measurements should be taken in the home, school
or in well-clinic visits over two or more weeks. (Guidelines
recommend a daily morning measurement and then an afternoon
measurement after dose of bronchodilator for two weeks.)
Personal best will need to be re-established annually for
children as they grow.
Reference 6 divides patients into two classes: a) those five
years and younger b) those older than five years. We clarify
that “older than five years” in calculation will
mean those patients at least six years old. (Earlier versions
of this measure stated the definition to include those patients
at least five years old.)
|
| 10. Influenza immunization annually |
The # of patients with a record of flu immunization in the
past 12 months divided by the # of patients in the registry.
Multiply by 100 to get percent. |
On the last day workday of each month from the registry:
count the # of patients who have a record of flu immunization
in the previous 12 months; count the total # of patients in
the registry. |
>90%
|
For those centers using PECS, we also plan to add information
about patients who have gotten a flu vaccination in the flu
season (1 September to 31 March.)
Reference 5.
|
| 11. Depression Screening (12 months) |
The # of patients with a documented screening for depression
in the past 12 months divided by the # of patients in the
registry. Multiply by 100 to get percent. |
On the last day workday of each month from the registry:
count the # of patients with a documented screening for depression
in the past 12 months; count the total # of patients in the
registry. |
>50%
|
You will need to specify the instrument(s) or method(s)
to be used for screening. We recognize that depression screening
for children differs from depression screening for adults.
References 9-11. |
