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The Importance of EHR Quality Measures & Asthma


Tina is 5 years old and presents to the emergency department with a 2-day history of coryza and cough with intermittent low-grade fever. She developed an audible wheeze and respiratory distress that was initially responsive to albuterol via a pressurized metered-dose inhaler and small-volume spacer. However, symptoms have recurred within 2 hours of albuterol administration. On exam, she is in visible respiratory distress with a respiratory rate of 40 breaths per minute and has accompanying accessory muscle use. Her oxygen saturations are 92% in room air, and on auscultation of her chest there is widespread polyphonic wheeze and equal air entry. She has an audible moist cough. After discharge she follows up with her primary care physician to review her asthma symptoms and medications.1

Which Asthma Quality Measures Count for Stage 1 2013 Meaningful Use?

Which Asthma Quality Measures Count for Stage 1 & 2 2014 Meaningful Use?

Measuring & Improving Asthma Status: A Real Impact on Your Patients

  • A double-blind study that followed use of the inhaled corticosteroid budesonide to treat mild persistent asthma in patients over 5 years found those who used budesonide:2
    • Were significantly less likely to require long acting beta agonists (9.3% vs. 6.3%)
    • Had 0.61 times the odds of experiencing one or more severe asthma-related event (an emergency intervention or hospitalization over the 5 years
  • A cross-sectional survey of 2,429 children aged 4-17 years across 20 pediatric practices found:3
    • An overall weighted prevalence of 46% for uncontrolled asthma symptoms
    • Occurrence of one or more asthma exacerbation (including an ED visit or hospitalization) in the previous 12 months was higher in children with uncontrolled asthma compared with children with controlled asthma (50% vs. 33%)
    • More children with uncontrolled asthma had missed 1 or more school day in the previous 4 weeks (67% vs. 29%)
  • A double blind placebo-controlled study found that of 306 randomized patients, those who took nedocromil sodium or cromolyn sodium had:4
    • Significant improvement in asthma severity within 2 weeks of treatment as compared with placebo. (P<0.001)

Conclusion

Assessing and managing Tina's asthma symptoms can help her breathe easier, avoid visits to the hospital, and significantly improve her quality of life. Even for mild persistent disease, doing an assessment to formally classify asthma then using appropriate controller medication makes a difference.

Clinical Quality Measure Information

Asthma Assessment

NQF# Description Numerator Denominator Exclusions
0001 Percentage of patients who were evaluated during at least one office visit for the frequency of daytime and nocturnal asthma symptoms All patients:
  • Evaluated during > 1 office visit for frequency of symptoms.
All patients:
  • 5-40 years of age
  • Actively diagnosed with asthma
  • None

Asthma: Pharmacologic Therapy

NQF# Description Numerator Denominator Exclusions
0047 Percentage of patients who were evaluated during at least one office visit for the frequency of daytime and nocturnal asthma symptoms All patients:
  • Prescribed the preferred long-term control medication; or
  • Prescribed an acceptable alternative treatment
All patient with:
  • Age 5 <= 40 years
  • With mild, moderate, or severe persistent asthma
  • Patient reason for not prescribing either the preferred long term control medication or an acceptable alternative

Use of Appropriate Medications for People with Asthma

NQF# Description Numerator Denominator Exclusions
NQF# Not Applicable Percentage of patients identified as having persistent asthma during the measurement year and the year prior to the measurement year and who were dispensed a prescription for either an inhaled corticosteroid or acceptable alternative medication during the measurement year All patients with medical record documentation of >> 1 written prescription for:
  • Inhaled corticosteroids;
  • Nedocromil;
  • Cromolyn sodium;
  • Leukotriene modifiers; or
  • methylxanthines
Systematic sample of patients with:
  • Age 5 <= 56 years of age, &
  • Persistent asthma
  • None

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.5

  1. Adapted from https://online.epocrates.com/u/29221098/Acute+asthma+exacerbation+in+children/Basics/Vignette Exit Disclaimer [online.epocrates.com] ; Accessed April 2, 2012
  2. Busse, WW., Pederson, S., Pauwels, RA., Tan, WC., Chen, Y., Lamm, CJ., O'Byrne, PM. " The inhaled steroid treatment as regular therapy in early asthma (START) study f-year follow-up; Effectiveness of early intervention with budesonide in mild persistent asthma." Journal of Allergy and Clinical Immunology. 121 (5), 2008: 1167-74
  3. Liu, AH., Gilsenan, AW., Stanford, RH., Lincourt, W., Ziemiecki, R., Ortega, H. "Status of asthma control in pediatric primary care: results from the pediatric asthma control characteristics and prevalence survey study (ACCESS)". Journal of Pediatric Medicine. 157, 2010: 276-81.
  4. Schwartz, HJ. Blumenthal, M. Brady R. Braun, S. Lockey, R. Myers, D. Mansfield, L. Mullarkey, M. Owens, G. Ratner, P. Respher, L. van As, A. "A comparative study of the clinical efficacy or nedocromil sodium and placebo: how does cromolyn sodium compare as an active control treatment?". Chest. 109. 1996: 945-52.
  5. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org] Accessed January 31, 2012

Produced by Meaningful Use Quality Workgroup - February 14, 2013

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