Asthma affects approximately 1 in 12 children in the United States (Akinbami, 2016). It is associated with increased hospitalizations and emergency department (ED) visits, as well as racial and ethnic disparities in outcomes (Cabana et al, 2006). A significant proportion of asthma hospitalizations can be avoided with appropriate primary care asthma management (Homer, 1996). There are many factors that can lead to a child with asthma receiving care in the ED: poor asthma control, severity of symptoms, decreased access to care, and ability to enact emergency care, among many others. There are also numerous factors and settings that impact the asthma ED measure, including schools, ED, acute care, access to specialist, and community, many of which must be considered in trying to reduce inappropriate ED use for pediatric asthma. Primary care quality improvement (QI) collaboratives have been shown to be effective in improving asthma care processes and decreasing asthma-related emergency department visits.
The goal of this toolkit is to provide an overview of the measure: Pediatric Asthma Emergency Department Use and explain how to develop and implement quality measurement and improvement strategies in primary care settings to reduce asthma-related ED visits. The measurement specifications and QI strategies can be used by states, health plans, health systems, improvement partners, and provider groups to successfully improve asthma care.
Measure Description
The Pediatric Asthma Emergency Department Use measure estimates the rate of ED visits for children ages 3-21 who are being managed for identifiable asthma, using specified definitions. The measure is reported as number of visits per 100 child-years.
Measure Steward
The measure stewards are the University of California San Francisco and the Children's Hospital at Montefiore.
End Users
Potential end users of the measure include local and state health departments, health plans, health systems, accountable care organizations, improvement partners, provider groups, and primary care practices/clinics.
This toolkit provides information about the measure, including specifications and reporting prepared by the measure stewards. The toolkit also describes QI activities that can achieved by working with primary care learning collaboratives to improve adherence to National Heart, Lung, and Blood Institute (NHLBI) guidelines and reduce unnecessary pediatric asthma ED use. The QI materials and resources provided were developed by IMPLEMENT for Child Health initiative, based in San Francisco, California, and the Vermont Child Health Improvement Program (VCHIP).
References
Akinbami LJ, Simon AE, Rossen LM. Changing Trends in Asthma Prevalence Among Children. Pediatrics 2016;137(1):1-7. doi:10.1542/peds.2015-2354
Cabana MD, Slish KK, Evans D, et al. Impact of Physician Asthma Care Education on Patient Outcomes. Pediatrics 2006;117(6):2149-2157.
Homer CJ, Szilagyi P, Rodewald L, et al. Does quality of care affect rates of hospitalization for childhood asthma? Pediatrics 1996;98(1):18-23.
