ABIM Asthma PIM™ Practice Improvement Module Measures Catalogue

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Measures (5) This PIM examines the care you provide to your patients by addressing key processes and outcomes of asthma care based on recommendations of the Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. The EPR 3 Guidelines on Asthma were developed by an expert panel commissioned by the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee, under the auspices of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.
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ABIM Asthma PIM™ Practice Improvement Module Measures Catalogue

  1. 1. ABIM Asthma PIM™ Practice Improvement Module Measures Catalogue
  2. 2. Asthma PIM Measures Catalog September 2010 TABLE OF CONTENTS Introduction .............................................................................................................................................................. 3 Outcomes of Care ................................................................................................................................................... 5 Processes of Care.................................................................................................................................................... 6 Patient Experience: Outcomes of Care .............................................................................................................. 12 Patient Experience: Processes of Care ............................................................................................................. 14Asthma Measure Catalog September 2010 Page 2 of 19
  3. 3. IntroductionThis catalogue provides information related to the American Board of Internal Medicine’s Asthma Practice ImprovementModule®. It is written in language that addresses the physician who might choose to complete this module, and it details thespecifics of the module. Included is information regarding: • Purpose and structuring of the module • Patient inclusion criteria • Detailed description of the measuresThis PIM examines the care you provide to your patients by addressing key processes and outcomes of asthma care based onrecommendations of the Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. The EPR 3Guidelines on Asthma were developed by an expert panel commissioned by the National Asthma Education and Prevention Program(NAEPP) Coordinating Committee, under the auspices of the National Heart, Lung, and Blood Institute (NHLBI) of the NationalInstitutes of Health.The PIM is divided into three parts, with multiple sections in each part.Part 1 -Performance DataProvide baseline data about your practices current performance by... • Surveying your patients • Reviewing your charts • Assessing your practice systemsThe 23 patient survey measures and 21 chart review measures are summarized below. ABIM recommends a minimum of 25 patientsurveys and 25 chart reviews. If you have extreme difficulty meeting this recommendation in a reasonable time frame, you maysatisfy this requirement with only ten surveys and ten charts.The practice systems assessment comprises questions covering various aspects of practice structure and protocols.Asthma Measure Catalog September 2010 Page 3 of 19
  4. 4. Patients can be included in this module if all of the following are true: 1. They are between the ages of 15 and 90 (inclusive); 2. Management decisions regarding their asthma are made primarily by providers in the practice; 3. They have been patients in the practice for at least one year; AND 4. They have been seen by the practice within the past 12 months.Patients should be excluded from this module if either of the following is true: 1. They are unable to complete the patient survey, even with assistance OR 2. They have a terminal illness, or treatment of their asthma is not clinically relevant.Part 2 - Quality Improvement (QI) PlanDevelop a plan for improving one aspect of your practice after reviewing the analysis of your current performance data. The analysiswill include many aspects of care you provide to your patients. Ultimately, you will target only one of these to use in this qualityimprovement (QI) cycle.Part 3 - RemeasurementRemeasure your performance data after you have implemented your QI plan to see if you achieved your goal. Then, you will reflect onthe process of developing and implementing a QI plan.You may claim CME credit for completing this activity. The University of Pennsylvania School of Medicine designates thiseducational activity for a maximum of 20 AMA PRA Category 1 Credit(s)TM.Asthma Measure Catalog September 2010 Page 4 of 19
  5. 5. Asthma - OUTCOMES OF CAREClinical OutcomesMeasure Title Description Numerator Denominator RationalePatient has minimal Patients in the sample who Number of patients in the sample Number of patients Frequency of symptoms is anasthma symptoms experienced severe asthma who experienced severe asthma in the sample important indicator of asthma symptoms twice a week or less, symptoms twice a week or less, severity and adequacy of control. during the month prior to the during the month prior to the Patient who report an increase in most recent visit most recent visit frequency or severity of symptoms may require more intensive treatment.Patient has minimal Patients in the sample who Number of patients in the sample Number of patients Nocturnal symptoms are common innighttime asthma experienced nighttime asthma who experienced nighttime in the sample asthma and should be addressed insymptoms symptoms twice a week or less, asthma symptoms twice a week a patients management plan. The during the month prior to the or less, during the month prior to frequency of nighttime awakenings most recent visit the most recent visit is an important indicator of disease severity and adequacy of control.Most recent FEV1 > Patients in the sample who had Number of patients in the sample Number of patients80% predicted spirometry done during the 24- who had spirometry done during in the sample month abstraction period, or the 24-month abstraction period, three months prior to the or three months prior to the abstraction period, and whose abstraction period, and whose FEV1 was >80% predicted FEV1 was >80% predicted0-1 exacerbation Patients in the sample who had Number of patients in the sample Number of patients Patients whose asthma is wellrequiring oral systemic 0-1 exacerbation requiring oral who had 0-1 exacerbation in the sample controlled typically have fewercorticosteroids within systemic corticosteroids within requiring oral systemic exacerbations. When exacerbationspast 12 months the past 12 months corticosteroids within the past 12 do occur, oral systemic months corticosteroids may be appropriate, except for the most mild and most severe episodes. Short courses have been shown to shorten the duration of episodes and may prevent hospitalization and relapse.Asthma Measure Catalog September 2010 Page 5 of 19
  6. 6. ASTHMA - PROCESSES OF CAREPatient EvaluationMeasure Title Description Numerator Denominator RationaleHistory of factors and Of the total number of responses Of the total number of responses Number of total A complete medical evaluationexposures that make for all patients in the sample, the for all patient in the sample, the responses to should be performed to classifyasthma symptom “Assessed” responses to number of “Assessed” responses questions about asthma, detect the presence ofcontrol more difficult questions about various factors to questions about various whether various complications, and assess risk and exposures that make control factors and exposures that make factors and factors in patients with established of asthma symptoms more control of asthma symptoms exposures make asthma. This information will assist difficult (chronic exposure to more difficult (chronic exposure control of asthma in formulating a management plan second-hand smoke; recurrent to second-hand smoke; recurrent symptoms more and provide a basis for continuing rhinitis and/or sinusitis; nasal rhinitis and/or sinusitis; nasal difficult and to the care. polyps; gastroesophageal reflux; polyps; gastroesophageal reflux; question about aspirin or NSAID sensitivity; aspirin or NSAID sensitivity; current smoking exercise-induced bronchospasm; exercise-induced bronchospasm; status fur-bearing pets in the home; fur-bearing pets in the home; moisture, dampness, or visible moisture, dampness, or visible mold in the home; cockroaches mold in the home; cockroaches in the home; outdoor allergens; in the home; outdoor allergens; workplace exposures; workplace exposures; stressors/stressful situations; stressors/stressful situations; depression; weather changes) depression; weather changes) and “Yes” or “No” responses for and “Yes” or “No” responses for current smoking status current smoking statusAsthma severity Patients in the sample whose Number of patients in the sample Number of patients Classification of asthma severity isclassification asthma severity classification is for whom asthma severity in the sample essential when initiating treatment.documented documented classification is documented Severity is best assessed in patients who are not using long-term control therapy. The two principle components of assessment are impairment (i.e., frequency and intensity of symptoms, functional limitations) and risk (i.e., likelihood of exacerbation or loss of lung function). A detailed classification scheme has been developed by the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute (NHLBI); refer to the Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma.Asthma Measure Catalog September 2010 Page 6 of 19
  7. 7. ASTHMA - PROCESSES OF CAREDiagnostic TestingMeasure Title Description Numerator Denominator RationaleSpirometry at any time Patients in the sample who had Number of patients in the sample Number of patients Spirometry is recommended as part spirometry done and whose who had spirometry done and in the sample of the initial patient evaluation, after results were documented whose results were documented therapy has begun and symptoms have stabilized, during times of increased symptoms and/or poor control, and at least every one to two years. More frequent testing may be appropriate for patients with severe asthma and those who have a poor response to therapy.Spirometry within past Patients in the sample who had Number of patients in this Number of patients Spirometry is recommended as parttwo years spirometry done during the 24- sample who had spirometry in the sample of the initial patient evaluation, after month abstraction period, or done during the 24-month therapy has begun and symptoms three months prior to the abstraction period, or three have stabilized, during times of abstraction period, and whose months prior to the abstraction increased symptoms and/or poor results were documented period, and whose results were control, and at least every one to documented two years. More frequent testing may be appropriate for patients with severe asthma and those who have a poor response to therapy.Office PEFR Patients in the sample whose Number of patients in the sample Number of patients A diagnosis of asthma is suggested peak expiratory flow rate (PEFR) whose PEFR has been in the sample when office measurement of PEFR has been measured in the office measured in the office and yields a value below the predicted. and results documented results documented The finding is not diagnostic, however. Improvement in PEFR after use of a bronchodilator provides further support for the diagnosis of asthma. PEFR values also can provide information to assist in monitoring asthma control, but they are not reliable measures of disease severity.Asthma Measure Catalog September 2010 Page 7 of 19
  8. 8. ASTHMA - PROCESSES OF CAREDiagnostic Testing (cont.)Measure Title Description Numerator Denominator RationaleAllergy testing at any Patients in the sample who had Number of patients in the sample Number of patients While patient history generally istime allergy testing done and whose who had allergy testing done and in the sample sufficient to determine sensitivity to results were documented whose results were documented seasonal allergens, allergy testing (skin or in vitro) usually is needed to determine sensitivity to perennial indoor allergens. Patients should be tested only for allergens to which they may be exposed, and clinicians should assess the relevance of any sensitivities that are noted. Test results also are an important element of patient education, specifically avoiding exposures.TreatmentMeasure Title Description Numerator Denominator RationaleShort-acting beta Patients in the sample for whom Number of patients in the sample Number of patients Short-acting beta agonists (SABAs)agonists (SABAs) SABAs are prescribed, except for whom SABAs are prescribed, in the sample, are the treatment of choice for acuteprescribed for all those with a contraindication to except those with a except those with a asthma symptoms andpatients SABAs contraindication to SABAs contraindication to exacerbations. They typically SABAs provide relief within 3-5 minutes. Routine scheduled daily use of SABAs is not recommended.Appropriate treatment Patients in the sample with Number of patients in the sample Number of patients Patients who have asthmafor intermittent asthma intermittent asthma for whom with intermittent asthma for in the sample with symptoms (daytime or nocturnal SABAs are prescribed, except whom SABAs are prescribed, intermittent asthma, awakenings) on two days per week those with a contraindication to except those with a except those with a or fewer, with no disruption of SABAs, but for whom long-term contraindication to SABAs, but contraindication to normal activity, can be classified as control medication was NOT for whom long-term control SABAs having intermittent asthma. Further, prescribed medication was NOT prescribed such patients should require use of a short-acting beta agonist (SABA) on two days per week or fewer.Asthma Measure Catalog September 2010 Page 8 of 19
  9. 9. ASTHMA – PROCESSES OF CARETreatment (cont.)Measure Title Description Numerator Denominator RationaleAppropriate treatment Patients in the sample with Number of patients in the sample Number of patients Patients with persistent asthmafor persistent asthma persistent asthma for whom both with persistent asthma for whom in the sample with require both a long-term control SABAs and long-term control both SABAs and long-term persistent asthma, medication and a short-acting medication, other than a LABA control medication, other than a except those with a medication to relieve acute alone, are prescribed, except LABA alone, are prescribed, contraindication to symptoms. LABAs should be used those with a contraindication to except those with a SABAs as adjunctive therapy, with an SABAs contraindication to SABAs inhaled corticosteroid.Inappropriate use of Patients in the sample with Number of patients in the sample Number of patients LABAs should be used aslong-acting beta persistent asthma for whom only with persistent asthma for whom in the sample with adjunctive therapy, with an inhaledagonists (LABAs) a LABA is prescribed only a LABA is prescribed persistent asthma corticosteroid. They are not and who have long- appropriate to treat acute symptoms term control or exacerbations, nor as medication as part of monotherapy for long-term control their treatment plan of persistent asthma.Patient uses short- Patients in the sample for whom Number of patients in the sample Number of patients Frequent use (>= 2 days/week) of aacting beta2-agonist <= a SABA is prescribed for quick for whom a SABA is prescribed in the sample for SABA for quick relief of asthma2 days/week relief of asthma symptoms and for quick relief of asthma whom a SABA is symptoms is a marker of poor who use it two days or less per symptoms and who use it two prescribed for quick control. week days or less per week relief of asthma symptomsPreventive CareMeasure Title Description Numerator Denominator RationaleInfluenza vaccine Patients in the sample who Number of patients in the sample Number of patients Influenza is a common, preventableduring most recent flu received influenza vaccination who received influenza in the sample infectious disease associated with highseason during the most recent flu vaccination during the most mortality and morbidity in the elderly and in people with chronic diseases. season recent flu season Observational studies of patients with a variety of chronic illnesses, including asthma, show an increase in hospitalizations for influenza and its complications. Influenza vaccine is widely underutilized in patients with asthma.Asthma Measure Catalog September 2010 Page 9 of 19
  10. 10. ASTHMA - PROCESSES OF CAREPreventive Care (cont.)Measure Title Description Numerator Denominator RationaleSmoking-cessation Patients in the sample who are Number of patients in the sample Number of patients A number of large randomizedcounseling at most smokers and who received who are smokers and for whom in the sample who clinical trials have demonstrated therecent visit smoking-cessation counseling or smoking-cessation counseling or are smokers efficacy and cost-effectiveness of treatment at their most recent treatment was documented at smoking-cessation counseling in visit their most recent visit changing smoking behavior and reducing tobacco use.Smoking cessation Patients in the sample who are Number of patients in this Number of patients A number of large randomizedcounseling within past smokers and who received sample who are smokers and for in this sample who clinical trials have demonstrated the12 months smoking-cessation counseling or whom smoking-cessation are smokers efficacy and cost-effectiveness of treatment during the 12-month counseling or treatment was smoking-cessation counseling in abstraction period documented during the 12- changing smoking behavior and month abstraction period or reducing tobacco use. three months prior to the abstraction periodPatient Self-Care SupportMeasure Title Description Numerator Denominator RationalePatient has written Patients in the sample who have Number of patients in the sample Number of patients All asthma patients should have aasthma management a written asthma-management who have a written asthma- in the sample written action plan that includesplan plan management plan both daily management, as well as how to recognize and handle worsening symptoms. The patient and physician should agree upon the plan, thus involving the patient directly in self-management. Written plans may be particularly important for patients who have moderate or severe persistent asthma, severe exacerbations, or poorly controlled asthma. Patients should be given a copy of their plan, which should be reviewed at every visit.Asthma Measure Catalog September 2010 Page 10 of 19
  11. 11. ASTHMA - PROCESSES OF CAREPatient Self-Care Support (cont.)Measure Title Description Numerator Denominator RationalePlan was created, Patients who had a written Number of patients in the sample Number of patients All asthma patients should have aupdated and/or asthma-management plan who had a written asthma- in the sample written action plan that includesreviewed at most recent created, updated, and/or management plan created, both daily management, as well asvisit reviewed at the most recent visit updated, and/or reviewed at their how to recognize and handle most recent visit worsening symptoms. The patient and physician should agree upon the plan, thus involving the patient directly in self-management. Written plans may be particularly important for patients who have moderate or severe persistent asthma, severe exacerbations, or poorly controlled asthma. Patients should be given a copy of their plan, which should be reviewed at every visit.Written copy of Patients in the sample who were Number of patients who were Number of patientsmanagement plan at given a written copy of their given a written copy of their in the sample whosemost recent visit asthma management plan asthma management plan written asthma- management plan was created, updated, or reviewed at their most recent visitAsthma Measure Catalog September 2010 Page 11 of 19
  12. 12. PATIENT EXPERIENCE: ASTHMA – OUTCOMES OF CAREClinical OutcomesMeasure Title Description Numerator Denominator RationalePatient has minimal Patients in the sample who Number of patients who Number of patients Nocturnal symptoms are common innighttime asthma reported that their asthma did responded “No” to the Survey who completed a asthma and should be addressed insymptoms – PtSrv not wake them up at night question “In the past four weeks, survey a patient’s management plan. The did your asthma wake you up at frequency of nighttime awakenings night?” is an important indicator of disease severity and adequacy of control.Patient states asthma is Patients in the sample who Number of surveyed patients Number of patients The goals of asthma treatment arewell controlled report that their asthma is well who responded “Yes” to the who completed a twofold: 1.) to decrease impairment, controlled question “In the past four weeks, survey including frequency and severity of did you feel that your asthma both daytime and nocturnal was well controlled?” symptoms, infrequent use of SABAs for acute symptoms, and normal activity levels; and 2.) to decrease the risk of exacerbations, ED visits, hospitalizations, and progressive loss of function. Physicians should assess patient expectations and work closely with patients to improve self-management skills and compliance.No ER visits for asthma Patients in the sample who Number of surveyed patients Number of patients In general, more frequent andin past year report having no ER visits for who responded “None” to the who completed a intense exacerbations (e.g., asthma during the past year question, “In the past 12 months, survey requiring urgent, unscheduled care, how many times did you go to hospitalization, or ICU admission) the emergency department indicate greater underlying disease because of your asthma severity. symptoms?”Asthma Measure Catalog September 2010 Page 12 of 19
  13. 13. PATIENT EXPERIENCE: ASTHMA – OUTCOMES OF CAREFunctional Outcomes and Self-CareMeasure Title Description Numerator Denominator RationaleNo activities missed Patients in the sample who Number of surveyed patients Number of patients A patients ability to maintain normalbecause of asthma report missing no activities who responded "No" to the who completed a activity levels, including exercise because of asthma question, "In the past 4 weeks, survey and attendance at work or school, is did you miss any work, school, an important indicator of disease or normal daily activity (for severity and control. example, household chores or social engagements) because of your asthma?"Good fitness level Patients in the sample who Number of surveyed patients Number of patients An important measure of asthma described their current level of who responded "Really in shape" who completed a severity and disease control is the fitness as "Really in shape" or "In or "In shape" to the question survey patients ability to maintain normal shape" "How would you describe your activity levels. This includes current level of fitness?" exercise and other physical activity, as well as attendance at work or school.Patient SatisfactionMeasure Title Description Numerator Denominator RationalePatient rates asthma Patients in the sample who rate Number of patients who Number of patients The goals of asthma treatment arecare "excellent" their asthma care as "excellent" responded "Excellent" to the who completed a twofold: 1.) to decrease impairment, survey question, "How would you survey including frequency and severity of describe your overall asthma both daytime and nocturnal care?" symptoms, infrequent use of SABAs for acute symptoms, and normal activity levels; and 2.) to decrease the risk of exacerbations, ED visits, hospitalizations, and progressive loss of function. Physicians should assess patient expectations and work closely with patients to improve self-management skills and compliance.Asthma Measure Catalog September 2010 Page 13 of 19
  14. 14. PATIENT EXPERIENCE: ASTHMA – PROCESSES OF CARETreatmentMeasure Title Description Numerator Denominator RationaleRescue inhaler alone Patients in the survey who Number of surveyed patients Number of patients Short-acting beta agonists (SABAs) reported use of a short-acting reporting use of a short-acting who completed a are the most effective treatment for beta agonist but no long-term beta agonist but no long-term survey acute symptoms. Routine scheduled control medication control medication daily use is not recommended, however. If SABAs are needed more than two days per week (or more than one canister per month), asthma is considered to be poorly controlled. Additional therapy should be recommended. Excess use of SABAs has been associated with an increased risk for severe exacerbations and death.Rescue inhaler plus Surveyed patients reporting use Number of surveyed patients Number of patients Patients with persistent asthmalong-term control of a short-acting beta agonist reporting use of a short-acting who completed a require treatment with both a long-medication and a long-term control beta agonist and a long-term survey term control medication and a quick- medication control medication relief medication. Long-term control medications include inhaled corticosteroids (ICSs), inhaled long- acting bronchodilators, leukotriene modifiers, cromolyn, theophylline, and immunomodulators. Of these, ICSs have been shown to be the most effective.Long-term control Surveyed patients reporting use Number of surveyed patients Number of patients Patients with persistent asthmamedication alone of long-term control medication reporting use of long-term who completed a require treatment with both a long- but no short-acting beta-agonist control medication but no short- survey term control medication and a quick- acting beta-agonist relief medication. Long-term control medications include inhaled corticosteroids (ICSs), inhaled long- acting bronchodilators, leukotriene modifiers, cromolyn, theophylline, and immunomodulators. Of these, ICSs have been shown to be the most effective.Asthma Measure Catalog September 2010 Page 14 of 19
  15. 15. PATIENT EXPERIENCE: ASTHMA – PROCESSES OF CARETreatment (cont.)Measure Title Description Numerator Denominator RationalePatient uses short- Patients in the sample who Number of surveyed patients Number of surveyed Frequent use (>= 2 days/week) of aacting beta2-agonist <= report using a SABA inhaler two who report using a SABA inhaler patients who report SABA for quick relief of asthma2 days /week - PtSrv days or less per week in the four two days or less per week in the using a SABA symptoms is a marker of poor week prior to completing the four weeks prior to completing inhaler control. survey the surveyPatient uses long-term Surveyed patients reporting use Number of surveyed patients Number of surveyed Patients with persistent asthmacontrol medication of long-term control medication reporting use of long-term patients who report require both a long-term controlevery day every day control medication every day. that for whom an medication and a short-acting asthma inhaler or pill medication to relieve acute that is NOT used for symptoms. Long-term control quick relief but is medications should be taken daily used to control for maximum effectiveness. asthma is prescribed.Preventive CareMeasure Title Description Numerator Denominator RationaleSmoking cessation Patients in the sample who Number of patients in the sample Number of surveyed A number of large randomizedcounseling - PtSrv responded "Yes, more than who responded "Yes, more than patients who are clinical trials have demonstrated the once" to the survey question "If once" to the survey question "If smokers efficacy and cost-effectiveness of you smoke, has your doctor you smoke, has your doctor smoking-cessation counseling in advised you to stop?" advised you to stop?" changing smoking behavior and reducing tobacco use.Help to stop smoking Patients in the sample who Number of surveyed patients Number of surveyed reported receiving assistance, who smoke and responded "Yes" patients who smoke medication, or a referral to help to the survey question, "Did you them stop smoking doctor offer you assistance, medication, or a referral to help you stop smoking?"Asthma Measure Catalog September 2010 Page 15 of 19
  16. 16. PATIENT EXPERIENCE: ASTHMA – PROCESSES OF CAREPatient Self-Care SupportMeasure Title Description Numerator Denominator RationaleAsthma attack Patients in the sample who Number of patients in the sample Number of patients All asthma patients should have a report knowing what to do for an who responded "Yes" to the who completed a written action plan that includes asthma attack survey question, "Do you have survey both daily management, as well as written instructions from your how to recognize and handle doctor or someone in the worsening symptoms. The patient practice on what to do if you are and physician should agree upon having an asthma attack?" the plan, thus involving the patient directly in self-management. Written plans may be particularly important for patients who have moderate or severe persistent asthma, severe exacerbations, or poorly controlled asthma. Patients should be given a copy of their plan, which should be reviewed at every visit.Inhaler use has been Patients in the sample who Number of patients in the sample Number of surveyed Experts recommend that a patientsobserved during past responded "Yes" to the survey who responded "Yes" to the patients who report inhaler technique be assessed atyear question, "In the past 12 months, survey question, "In the past 12 using an inhaler for every visit. This is an important has your doctor or someone in months, has your doctor or quick relief from component of self-management the doctors office watched you someone in the doctors office asthma symptoms education for all asthma patients. use an inhaler to make sure you watched you use an inhaler to Elderly asthma patients may need use it correctly?" make sure you use it correctly?" additional attention because inhaler use can be compromised by physical and/or cognitive impairments.Patient reports shared Patients in the sample who Number of patients in the sample Number of patients Care should be patient-centered,decision-making about report that they share decision- who responded "Yes" to the who completed a respectful of and responsive to individualasthma treatment making about their asthma survey question "Do you and survey patient preferences, needs, and values and ensuring that patient values guide treatment with their doctor your doctor share decision- all clinical decisions. Patients overall making about your asthma experiences with doctors are shaped by care?" communication style and content and both contribute to the likelihood that a patient will understand and be able to follow treatment recommendations.Asthma Measure Catalog September 2010 Page 16 of 19
  17. 17. PATIENT EXPERIENCE: ASTHMA – PROCESSES OF CAREPatient Self-Care Support (cont.)Measure Title Description Numerator Denominator RationalePractice is excellent at Patients in the sample who rated Number of patients who Number of patients Care should be patient-centered,encouraging questions the practice "excellent" at responded "Excellent" to the who completed a respectful of and responsive toand answering them encouraging questions and survey question, "How is this survey individual patient preferences,clearly answering them clearly practice at encouraging needs, and values and ensuring questions and answering them that patient values guide all clinical clearly?" decisions. Patients overall experiences with doctors are shaped by communication style and content and both contribute to the likelihood that a patient will understand and be able to follow treatment recommendations.Practice is excellent at Patients in the sample who rated Number of patients who Number of patients Care should be patient-centered,going over how to take the practice "excellent" at going responded "Excellent" to the who completed a respectful of and responsive toasthma medications over how to take asthma survey question, "How is this survey individual patient preferences, medications practice at going over how to needs, and values and ensuring take your medications?" that patient values guide all clinical decisions. Patients overall experiences with doctors are shaped by communication style and content and both contribute to the likelihood that a patient will understand and be able to follow treatment recommendations.Practice is excellent at Patients in the sample who rated Number of patients in the sample Number of patients Care should be patient-centered,providing information on the practice "excellent" at who responded “Excellent” to the who completed a respectful of and responsive toside effects of providing information on side survey question, "How is this survey individual patient preferences,medications effects of medications practice at providing information needs, and values and ensuring on side effects of medications?" that patient values guide all clinical decisions. Patients overall experiences with doctors are shaped by communication style and content and both contribute to the likelihood that a patient will understand and be able to follow treatment recommendations.Asthma Measure Catalog September 2010 Page 17 of 19
  18. 18. PATIENT EXPERIENCE: ASTHMA – PROCESSES OF CAREPatient Self-Care Support (cont.)Measure Title Description Numerator Denominator RationalePractice is excellent at Patients in the sample who rated Number of patients in the sample Number of patients A variety of exposures can inducereviewing asthma the practice "excellent" at who responded “Excellent” to the who completed a or trigger symptoms of asthma.triggers reviewing asthma triggers patient survey question, "How is survey Common triggers include cigarette this practice at reviewing asthma smoke, dust mites, air pollution, and triggers?" pets. Triggers can be patient- specific, so it is important that each patient is aware of what his/her triggers are and how they can be avoided. This is a critical element of patient self-management.Access to PracticeMeasure Title Description Numerator Denominator RationalePatient reports no Patients in the sample who Number of patients in the sample Number of patients A key expectation for many patientsproblem with report no problems scheduling who responded "Not a problem" in the sample, is the ability to get medical carescheduling appointments with the practice to the survey question, "In the excluding those who when they believe they need it.appointments past 12 months, how much of a responded "Not problem has it been to schedule applicable" to the appointments with this practice?" survey question, "In the past 12 months, how much of a problem has it been to schedule appointments with this practice?"Patient reports no Patients in the sample who Number of patients in the sample Number of patients in The Institute of Medicine (IOM)problem with reaching report no problems reaching the who responded "Not a problem" the sample, excluding recommends that patients receive caresomeone with a practice with questions or to the survey question, "In the those who responded whenever they need it and in many "Not applicable" to the forms, not just face-to-face visits. Thisquestion concerns past 12 months, how much of a survey question, "In the implies that the health care system problem has it been to reach this past 12 months, how should be responsive at all times (24 practice when you have a much of a problem has hours a day, every day) and that access question or concern?" it been to reach this to care should be provided over the practice when you Internet, by telephone, and by other have a question or means in addition to face-to-face visits. concern?"Asthma Measure Catalog September 2010 Page 18 of 19
  19. 19. PATIENT EXPERIENCE: ASTHMA – PROCESSES OF CAREAccess to Practice (cont.)Measure Title Description Numerator Denominator RationalePatient reports no Patients in the sample who Number of patients in the sample Number of patients The Institute of Medicine (IOM)problem with obtaining report no problems obtaining who responded "Not a problem" in the sample, recommends that patients receiveprescription refills prescription refills to the survey question, "In the excluding those who care whenever they need it and in past 12 months, how much of a responded "Not many forms, not just face-to-face problem has it been to get a applicable" to the visits. This implies that the health prescription refill from this survey question, "In care system should be responsive practice?" the past 12 months, at all times (24 hours a day, every how much of a day) and that access to care should problem has it been be provided over the Internet, by to get a prescription telephone, and by other means in refill from this addition to face-to-face visits. practice?"© 2010 American Board of Internal Medicine. All rights reserved. ABIM publications are protected by United States and international copyright laws. Written permission for any reproduction oradaptation, in whole or in part, in any format or medium must be obtained from ABIM. Contact request@abim.org.Asthma Measure Catalog September 2010 Page 19 of 19

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