Skip Navigation
QualityTool

Asthma Care Quality Improvement: A Resource Guide for State Action


Description

This 151-page resource guide was developed as a learning tool for State officials who want to improve the quality of health care for people with asthma in their States. The guide is designed to help officials assess quality of care, using State-level data, and fashion quality improvement strategies suited to State conditions. The Resource Guide and its complementary Workbook can serve as tools for sharing the expertise, ideas, knowledge, and solutions of those involved in quality improvement. The various modules are intended for different users.

This resource guide is divided into the following five modules:

  • Module 1: Making the case for asthma care quality improvement
    • Making the case for quality improvement
    • The quality improvement opportunity
    • Estimating the costs of asthma care and potential savings from quality improvement 
  • Module 2: A framework for State-led quality improvement
    • Quality health care and quality improvement movement
    • A strategic role for States
    • Developing a framework for State-led quality improvement
    • Information resources for quality improvement
  • Module 3: Learning from current State quality improvement efforts
  • Module 4: Measuring quality of care for asthma
    • Quality measurement
    • Multiple dimensions of quality for asthma care
    • Data sources for asthma quality care
    • Using benchmarks to develop State performance estimates
    • Factors that affect quality of asthma care
  • Module 5: Moving ahead—Implications for State action

The resource guide also includes the following appendixes:

  • Medicaid spending on asthma by State
  • National and State asthma programs
  • Asthma measures
  • Behavioral Risk Factor Surveillance System (BRFSS) measures, data, and benchmarks
  • Other asthma-related data sources
  • Benchmarks from the National Healthcare Quality Report (NHQR)
  • Information on statistical significance
Links to the Tool:
The resource guide is available at:: http://www.ahrq.gov/asthmaresourceguide.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)
The workbook is available at:: http://www.ahrq.gov/asthmacqwork.pdf

Developer

The Council of State Governments; Thomson Medstat

Funding Sources

Agency for Healthcare Research and Quality


QualityTool Topic

asp:qt-topic-replace-me


Related Resources

  • Agency for Healthcare Research and Quality (AHRQ). Management of chronic asthma. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2001 Sep. 448 p. (Evidence report/technology assessment; no. 44).
  • Agency for Healthcare Research and Quality (AHRQ). National healthcare disparities report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2003 Jul.
  • Agency for Healthcare Research and Quality (AHRQ). National healthcare disparities report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2004 Dec. 152 p.
  • Agency for Healthcare Research and Quality (AHRQ). National healthcare quality report. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2004 Dec. 112 p.
  • American Lung Association, Epidemiology and Statistics Unit. Trends in asthma morbidity and mortality. New York (NY): American Lung Association; 2005.
  • Atherly A, Williams S, Redd S. What is the cost of asthma to employers? Drug Benefit Trends 2003;15(11):35-46.
  • Becklake MR, Ernst P. Environmental factors. Lancet 1997 Oct;350 Suppl:SII10-3. [48 references] PubMed
  • Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA 2002 Oct 16;288(15):1909-14. PubMed
  • Boudreaux ED, Emond SD, Clark S, Camargo CA Jr. Acute asthma among adults presenting to the emergency department: the role of race/ethnicity and socioeconomic status. Chest 2003 Sep;124(3):803-12. PubMed
  • Brodsky KL. Overcoming financial barriers to improving asthma care for children. Lawrenceville (NJ): Center for Health Care Strategies; 2002 Mar. 8 p.
  • Brown R, Bratton SL, Cabana MD, Kaciroti N, Clark NM. Physician asthma education program improves outcomes for children of low-income families. Chest 2004 Aug;126(2):369-74. PubMed
  • Cabana MD, Ebel BE, Cooper-Patrick L, Powe NR, Rubin HR, Rand CS. Barriers pediatricians face when using asthma practice guidelines. Arch Pediatr Adolesc Med 2000 Jul;154(7):685-93. PubMed
  • Celedon JC, Sredl D, Weiss ST, Pisarski M, Wakefield D, Cloutier M. Ethnicity and skin test reactivity to aeroallergens among asthmatic children in Connecticut. Chest 2004 Jan;125(1):85-92. PubMed
  • Centers for Disease Control and Prevention (CDC). Asthma prevalence, health care use and mortality, 2002. Atlanta (GA): U.S. Department of Health and Human Services; 2004. various p.
  • Centers for Disease Control and Prevention, National Heart, Lung, and Blood Institute, National Institutes of Health. Key clinical activities for quality asthma care: recommendations of the National Asthma Education and Prevention Program. Atlanta (GA): U.S. Department of Health and Human Services; 2003. 12 p.
  • Centers for Medicare and Medicaid Services. Centers for Medicare and Medicaid Services' quality improvement roadmap, July 2005. Baltimore (MD): U.S. Department of Health and Human Services; 2005.
  • Chassin MR. Is health care ready for Six Sigma quality. Milbank Q 1998;76(4):565-91, 510. [62 references] PubMed
  • Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington (DC): National Academies Press; 2003. 764 p.
  • de Asis ML, Greene R. A cost-effectiveness analysis of a peak flow-based asthma education and self-management plan in a high-cost population. J Asthma 2004 Aug;41(5):559-65. [25 references] PubMed
  • Dey AN, Schiller JS, Tai DA. Summary health statistics for U.S. children: National Health Interview Survey, 2002. Vital Health Stat 10 2004 Mar;(221):1-78. PubMed
  • Dudley RA. Pay-for-performance research: how to learn what clinicians and policy makers need to know. JAMA 2005 Oct 12;294(14):1821-3. PubMed
  • Dyer MB, Bailit M, Kokenyesi C. Are incentives effective in improving the performance of managed care plans? Lawrenceville (NJ): Center for Health Care Strategies, Inc.; 2002 Mar. 71 p.
  • Farber HJ, Capra AM, Finkelstein JA, Lozano P, Quesenberry CP, Jensvold NG, Chi FW, Lieu TA. Misunderstanding of asthma controller medications: association with nonadherence. J Asthma 2003 Feb;40(1):17-25. PubMed
  • Goetzel R, Ozminkowski R, Villagra V, et al. Return on investment in disease management: a review. Health Care Financ Rev 2005;26(4):1-19.
  • Grant EN, Moy JN, Turner-Roan K, Daugherty SR, Weiss KB. Asthma care practices, perceptions, and beliefs of Chicago-area primary-care physicians. Chicago Asthma Surveillance Initiative Project Team. Chest 1999 Oct;116(4 Suppl 1):145S-154S. PubMed
  • Greineder DK, Loane KC, Parks P. A randomized controlled trial of a pediatric asthma outreach program. J Allergy Clin Immunol 1999 Mar;103(3 Pt 1):436-40. PubMed
  • Griswold SK, Nordstrom CR, Clark S, Gaeta TJ, Price ML, Camargo CA Jr. Asthma exacerbations in North American adults: who are the "frequent fliers" in the emergency department?. Chest 2005 May;127(5):1579-86. PubMed
  • Institute of Medicine. Lohr K, editor. Medicare: a strategy for quality assurance, Vol 2. Washington (DC): National Academy Press; 1990.
  • Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health care system for the 21st century. Washington (DC): National Academy Press; 2001.
  • Institute of Medicine. The Richard and Hinda Rosenthal lectures, 2002: fostering rapid advances in health care. Washington (DC): National Academy Press; 2003.
  • Joint Commission on Accreditation of Healthcare Organizations. Asthma performance measurement implementation guide disease-specific care. Oakbrook Terrace (IL): Joint Commission on Accreditation of Healthcare Organizations; 2004.
  • Kelly CS, Morrow AL, Shults J, Nakas N, Strope GL, Adelman RD. Outcomes evaluation of a comprehensive intervention program for asthmatic children enrolled in medicaid. Pediatrics 2000 May;105(5):1029-35. PubMed
  • King ME, Mannino DM, Holguin F. Risk factors for asthma incidence. A review of recent prospective evidence. Panminerva Med 2004 Jun;46(2):97-110. [66 references] PubMed
  • Koren HS. Environmental risk factors in atopic asthma. Int Arch Allergy Immunol 1997 May-Jul;113(1-3):65-8. [27 references] PubMed
  • Langley G, Nolan K, Nolan T, Norman C, Provost L. The improvement guide: a practical approach to enhancing organizational performance. San Francisco (CA): Jossey-Bass Publishers; 1996. 6-11 p.
  • Lara M, Nicholas W, Morton S, Vaiana ME, Genovese B, Rachelefsky G. Improving childhood asthma outcomes in the United States: a blueprint for policy action. Santa Monica (CA): RAND; 2001. 114 p.
  • Lieu TA, Lozano P, Finkelstein JA, Chi FW, Jensvold NG, Capra AM, Quesenberry CP, Selby JV, Farber HJ. Racial/ethnic variation in asthma status and management practices among children in managed Medicaid. Pediatrics 2002 May;109(5):857-65. PubMed
  • Lin S, Fitzgerald E, Hwang SA, Munsie JP, Stark A. Asthma hospitalization rates and socioeconomic status in New York State (1987-1993). J Asthma 1999 May;36(3):239-51. PubMed
  • Lozano P, Finkelstein JA, Hecht J, Shulruff R, Weiss KB. Asthma medication use and disease burden in children in a primary care population. Arch Pediatr Adolesc Med 2003 Jan;157(1):81-8. PubMed
  • Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC. Surveillance for asthma—United States, 1980-1999. MMWR Surveill Summ 2002 Mar 29;51(1):1-13. PubMed
  • Mannino DM, Homa DM, Pertowski CA, Ashizawa A, Nixon LL, Johnson CA, Ball LB, Jack E, Kang DS. Surveillance for asthma—United States, 1960-1995. MMWR CDC Surveill Summ 1998 Apr 24;47(1):1-27. PubMed
  • Mayo PH, Richman J, Harris HW. Results of a program to reduce admissions for adult asthma. Ann Intern Med 1990 Jun 1;112(11):864-71. PubMed
  • McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med 2003 Jun 26;348(26):2635-45. PubMed
  • Medical Expenditure Panel Survey (MEPS). [Web site]. Rockville (MD): Agency for Healthcare Research and Quality; 2002 [accessed 2003 Apr 14].
  • Milstein RL, Wetterhall SF, et al. Framework for program evaluation in public health. MMWR Recomm Rep 1999 Sep 17;48(RR-11):1-40. PubMed
  • National Asthma Education and Prevention Program (NAEPP). NAEPP expert panel report 2: guidelines for the diagnosis and management of asthma. Bethesda (MD): U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute; 1997 Jul. 146 p.
  • National Center for Health Statistics. Nine million U.S. children diagnosed with asthma, new reoprt finds. Fact sheet. Atlanta (GA): Centers for Disease Control and Prevention; 2004 Mar 31. various p.
  • National Heart, Lung, and Blood Institute. Key clinical activities for quality asthma care: recommendations of the National Asthma Education and Prevention Program. Rockville (MD): U.S. Department of Health and Human Services; 2003. 10 p.
  • National Institutes of Health, National Heart, Lung, and Blood Institute. Data fact sheet: asthma statistics. Bethesda (MD): U.S. Department of Health and Human Services; 1999 Jan 1.
  • National Jewish Medical and Research Center. Asthma Disease Management program analysis. [internet]. Denver (CO): National Jewish Medical and Research Center; 2004 Feb 12 [accessed 2006 Jul 14]. [various p].
  • Owens PL, Thompson J, Elixhauser A, et al. Care of children and adolescents in U.S. hospitals. HCUP Fact Book No. 4. AHRQ Publication no. 04-0004. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2003 Oct [accessed 2004 Sep 30]. [11 p].
  • Peterson-Sweeney K, McMullen A, Yoos HL, Kitzman H. Parental perceptions of their child's asthma: management and medication use. J Pediatr Health Care 2003 May-Jun;17(3):118-25. PubMed
  • Ray NF, Thamer M, Fadillioglu B, Gergen PJ. Race, income, urbanicity, and asthma hospitalization in California: a small area analysis. Chest 1998 May;113(5):1277-84. PubMed
  • Rossiter LF, Whitehurst-Cook MY, Small RE, Shasky C, Bovbjerg VE, Penberthy L, Okasha A, Green J, Ibrahim IA, Yang S, Lee K. The impact of disease management on outcomes and cost of care: a study of low-income asthma patients. Inquiry 2000 Summer;37(2):188-202. PubMed
  • Rust GS, Murray V, Octaviani H, Schmidt ED, Howard JP, Anderson-Grant V, Willard-Jelks K. Asthma care in community health centers: a study by the Southeast Regional Clinicians' Network. J Natl Med Assoc 1999 Jul;91(7):398-403. PubMed
  • Smith DH, Malone DC, Lawson KA, Okamoto LJ, Battista C, Saunders WB. A national estimate of the economic costs of asthma. Am J Respir Crit Care Med 1997 Sep;156(3 Pt 1):787-93. PubMed
  • Spanyi A, Wurtzel M. Six Sigma for the rest of us. Chico (CA): Quality Digest; 2003 Jul. various p.
  • Stanton MW, Dougherty D, Rutherford MK. Chronic care for low-income children with asthma: strategies for improvement. AHRQ pub. no. 05-0073. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2005.  (Research in action; no. 18).
  • Sullivan S, Elixhauser A, Buist AS, Luce BR, Eisenberg J, Weiss KB. National Asthma Education and Prevention Program working group report on the cost effectiveness of asthma care. Am J Respir Crit Care Med 1996 Sep;154(3 Pt 2):S84-95. PubMed
  • Sullivan SD, Weiss KB, Lynn H, Mitchell H, Kattan M, Gergen PJ, Evans R, National Cooperative Inner-City Asthma Study (NCICAS) Investigators. The cost-effectiveness of an inner-city asthma intervention for children. J Allergy Clin Immunol 2002 Oct;110(4):576-81. PubMed
  • Thorne PS, Kulhankova K, Yin M, Cohn R, Arbes SJ Jr, Zeldin DC. Endotoxin exposure is a risk factor for asthma: the National Survey of Endotoxin in United States Housing. Am J Respir Crit Care Med 2005 Dec 1;172(11):1371-7. PubMed
  • U.S. Department of Health and Human Services. Prevention makes common 'cents'. Washington (DC): U.S. Department of Health and Human Services; 2003 Sep. various p.
  • Weiss KB, Sullivan SD, Lyttle CS. Trends in the cost of illness for asthma in the United States, 1985-1994. J Allergy Clin Immunol 2000 Sep;106(3):493-9. PubMed
  • Weiss KB, Sullivan SD. The health economics of asthma and rhinitis. I. Assessing the economic impact. J Allergy Clin Immunol 2001 Jan;107(1):3-8. [50 references] PubMed
  • Williams D. Race socioeconomic status, and health: the added effects of racism and discrimination. In: Adler NE, Marmot M, McEwen BS, Stewart J, editor(s). Socioeconomic status and health in industrial nations. New York (NY): New York Academy of Sciences; 1999.
  • Yoos HL, Kitzman H, McMullen A. Barriers to anti-inflammatory medication use in childhood asthma. Ambul Pediatr 2003 Jul-Aug;3(4):181-90. PubMed
  • Zeiger RS, Heller S, Mellon MH, Wald J, Falkoff R, Schatz M. Facilitated referral to asthma specialist reduces relapses in asthma emergency room visits. J Allergy Clin Immunol 1991 Jun;87(6):1160-8. PubMed
  • Zoratti EM, Havstad S, Rodriguez J, Robens-Paradise Y, Lafata JE, McCarthy B. Health service use by African Americans and Caucasians with asthma in a managed care setting. Am J Respir Crit Care Med 1998 Aug;158(2):371-7. PubMed

History

  • Release Date: 04/2006
  • Original Summary: 07/2006
Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.
QualityTool Classification
Disease/Clinical Category:

Last updated: December 18, 2013.