How many asthma patients receive appropriate treatment to help control their asthma and avoid hospital and ER visits?

Among managed care enrollees (ages 5 to 56) with persistent asthma, 86 percent to 90 percent received an appropriate medication to prevent asthma flare-ups in 2005. From 2000 to 2004, performance improved by 8 to 10 percentage points.

Why is this important?

• Asthma is the sixth-most prevalent chronic disease overall and the most prevalent chronic disease in children. About 20 million Americans—including 6 million children and adolescents—have current asthma (ALA 2005).
• Asthma results in almost 500,000 hospitalizations, 14 million missed school days, 15 million lost work days, and 4,100 deaths each year in the United States. Economic costs amount to $11.5 billion for treatment and $4.6 billion in lost productivity (ALA 2006).
• National guidelines recommend that asthma patients control environmental triggers and receive regular monitoring, patient education, and appropriate drug therapy (NAEPP 1997, 2002). Those with persistent asthma who take medication (such as an inhaled corticosteroid) to control underlying airway inflammation have fewer asthma exacerbations, emergency room visits, and hospitalizations (Adams et al. 2001; Berger et al. 2004; Sin et al. 2004).

Findings

• In 2005, among managed care enrollees ages 5 to 56 who were most likely to need long-term treatment to control persistent asthma, 86 percent in Medicaid plans and 90 percent in private plans received at least one prescription for an appropriate medication.
• Performance improved from 2000 to 2004 in both private and Medicaid plans and remained higher in private plans than in Medicaid plans during this time. (These data are not directly comparable to 2005 because the criteria for defining patients with persistent asthma were redefined in 2005.)
• In 2000, adults were somewhat more likely than children and adolescents to receive controller medications. In 2005, young children were somewhat more likely than adults to receive controller medication (NCQA 2006a).

Implications

• National physician visit data show an eightfold increase in the prescription of medications to control asthma from 1978 to 2002 (Stafford et al. 2003). Deaths and hospitalizations due to asthma have decreased in the last few years (ALA 2005), possibly from better disease management.
• Improving asthma management to the level achieved in the highest-performing health plans could save up to $1.9 billion in lost productivity by preventing 11.8 million lost or reduced work days each year (NCQA 2006a).

Improvement Ideas and Resources

Improvement in asthma management requires a planned partnership between health care professionals and patients (and parents of children) to address concerns and establish treatment goals (Bender 2002). Asthma patient self-management education programs reduce adverse outcomes such as activity limitations, work and school absences, emergency room visits, and hospitalizations (Gibson et al. 2003; Wolf et al. 2003). Other interventions and practices that have been associated with improved asthma care and outcomes include:

• Case management and support by trained nurses or social workers (Delaronde et al. 2005; Kelly et al. 2000; Lozano et al. 2004; Sullivan et al. 2002; Tinkelman and Wilson 2004);
• Follow-up education for patients who visit the emergency room with asthma exacerbations, along with linkage to ongoing care (Teach et al. 2006);
• Guideline- and skills-oriented professional training, combined with administrative support to promote change (Clark et al. 1998; Evans et al. 1997); and
• Cultural competence policies and performance feedback for physicians treating Medicaid-insured children (Lieu et al. 2004).

The National Asthma Education and Prevention Program provides resources and tools to help health professionals support patients with asthma management, including a list of key clinical activities to promote quality asthma care (Williams et al. 2003). The National Center for Environmental Health has compiled a list of potentially effective interventions for asthma.

Measure:

The denominator includes health plan members who were likely to have persistent asthma (based on use of services and medications for asthma), who were ages 5 to 9 years, 10 to 17 years, or 18 to 56 years by December 31st of the measurement year and who were continuously enrolled during the measurement year and the year prior to the measurement year (with no more than one 45-day gap in enrollment in each year).

The measure was revised in 2005 to include only individuals identified as having persistent asthma in both the measurement year and the year prior to the measurement year (rather than only in year prior to the measurement year). This revision more narrowly targets patients likely to benefit from controller medication (Fuhlbrigge et al. 2005). As a result, 2005 data are not directly comparable to data from prior years.

The numerator includes those in the denominator who had at least one dispensed prescription during the measurement year for a medication for long-term asthma control recommended by guidelines of the National Asthma Education and Prevention Program (NAEPP 1997, 2002): an inhaled corticosteroid, nedocromil, cromolyn sodium, leukotriene modifier, or methylxanthine (NCQA 2006b).

Limitations:

These data are not nationally representative. Prior to being revised in 2005, the measure might have included some people with asthma who did not require daily controller medication (Cabana et al. 2004). The measure does not indicate whether patients consistently received or adhered to controller medication during the year or whether they achieved asthma control. "The definition used for 'persistent' asthma is a rough approximation . . . rather than a clinical measure of severity. This definitional approach was chosen for logistical and feasibility reasons so that an efficient, reasonably standardized and sufficiently large population that allows unbiased . . . comparisons could be identified through administrative sources" (NCQA 2006b). The ratio of controller medications to total asthma medications might be a better measure of the ability to prevent adverse asthma outcomes (Schatz et al. 2005).

Source:

National Committee for Quality Assurance (NCQA 2006a) Quality Compass data represent Health Plan Employer Data and Information Set (HEDIS) results submitted to NCQA for public dissemination by commercial and Medicaid health plans. Data for this measure are collected from administrative claims data.

References:

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