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## Complete Summary

#### TITLE

Asthma: percent of patients evaluated for environmental triggers other
than environmental tobacco smoke (dust mites, cats, dogs, molds/fungi,
cockroaches) either by history of exposure and/or by allergy testing.

#### SOURCE(S)

HDC topics: asthma. \[internet\]. Rockville (MD): HRSA Health
Disparities Collaboratives; 2005\[accessed 2005 Mar 31\]. \[8 p\].

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percent of patients evaluated for
environmental triggers other than environmental tobacco smoke (dust
mites, cats, dogs, molds/fungi, cockroaches) either by history of
exposure and/or by allergy testing.

**Note**: This measure and the \"Exposure to Environmental Tobacco
Smoke\" measure (see the related National Quality Measures Clearinghouse
\[NQMC\] summary of the HRSA HDC measure [Asthma: percent of patients
with a reported exposure to environmental tobacco smoke at last visit
measure](http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=6912&string=1613))
can overlap with the \"Current Self-management Goal\" measure (see the
related NQMC summary of the HRSA HDC measure [Asthma: percent of
patients with documented self-management goals in the last 12
months](http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=6910&string=1611))
in that a patient and provider can work to reduce exposure to a trigger
as a self-management goal.

#### RATIONALE

Asthma is a chronic lung condition that increasingly is being recognized
as a major international public health challenge. But although asthma is
a chronic respiratory disease, much can be done to manage the symptoms.
Never before have we had so many good, safe oral and inhaled drugs for
the treatment of asthma as we do today. Evidence-based guidelines have
been proven to be effective in improving the daily lives of patients
with this disease.

Unfortunately, despite our progress, we know that many individuals with
asthma still suffer unnecessarily from the symptoms of disease.
Guideline implementation lags in many practices across the country. In a
healthcare system designed around acute care, chronic illnesses
including asthma are not managed as effectively as they could be.
Translating research into practice is not as easy as it sounds, even
when we know it is the right thing to do.

The Asthma Collaborative is designed to help healthcare providers
improve the care they provide to people with asthma. Focusing on
specific measures that are based on clinical guidelines, practices
concentrate on changes that truly make a difference. By providing tools
and proven strategies to change the way asthma care is delivered, the
Asthma Collaborative has improved the lives of thousands with asthma.

This measure is one of 11 measures that participants track in the HRSA
Health Disparities Collaborative for Asthma.

#### PRIMARY CLINICAL COMPONENT

Asthma; environmental triggers; assessment

#### DENOMINATOR DESCRIPTION

Total number of patients with asthma in the registry

#### NUMERATOR DESCRIPTION

The number of patients from the denominator evaluated for environmental
triggers other than environmental tobacco smoke (dust mites, cats, dogs,
molds/fungi, cockroaches) either by history of exposure and/or by
allergy testing

**Note**: The \"indoor\" environmental triggers here are those having
the strongest evidence of causal relationship to asthma.

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

HDC topics: asthma. \[internet\]. Rockville (MD): HRSA Health
Disparities Collaboratives; 2005\[accessed 2005 Mar 31\]. \[8 p\].

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Collaborative inter-organizational quality improvement\
Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Community Health Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Physician Assistants\
Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Group Clinical Practices

#### TARGET POPULATION AGE

Unspecified

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Asthma effects between 14 and 15 million people in the United States
alone. There are 4.8 million children with asthma in the U.S. During the
past 15 years, its prevalence around the world has doubled.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

HDC topics: asthma. \[internet\]. Rockville (MD): HRSA Health
Disparities Collaboratives; 2005\[accessed 2005 Mar 31\]. \[8 p\].

Institute for Healthcare Improvement. Health Disparities Collaboratives
changing practice, changing lives: asthma training manual. Cambridge
(MA): Institute for Healthcare Improvement; 2002. 71 p.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

In the U.S., rates of asthma deaths, hospitalizations, and emergency
department visits have been increasing for more than two decades,
especially among African Americans and children. Since 1979--82, the
average age-adjusted asthma death rate for blacks has increased 71
percent versus 41 percent for Caucasians, and in 1995--98, the death
rate was almost three times that of Caucasians.

Similarly, between 1992 and 1998, rates of emergency department visits
for asthma increased, with the greatest increase in children ages
10--17. Children under 5 accounted for the highest rates of emergency
department visits. Hospitalization rates also rose during this time
period. Between 1979--81 and 1997--99, hospitalization rates for
children under 5 increased 48 percent. In 1997--99, hospitalization
rates were more than three times higher for African Americans than for
whites.

#### EVIDENCE FOR ASSOCIATION WITH VULNERABLE POPULATIONS

Institute for Healthcare Improvement. Health Disparities Collaboratives
changing practice, changing lives: asthma training manual. Cambridge
(MA): Institute for Healthcare Improvement; 2002. 71 p.

#### BURDEN OF ILLNESS

In 2000, there were 100 million total days of restricted activity among
persons with asthma and 5,000 deaths of asthma.

See also the \"Association with Vulnerable Populations\" field.

#### EVIDENCE FOR BURDEN OF ILLNESS

Institute for Healthcare Improvement. Health Disparities Collaboratives
changing practice, changing lives: asthma training manual. Cambridge
(MA): Institute for Healthcare Improvement; 2002. 71 p.

#### UTILIZATION

In 2000, the annual hospitalization rate among persons with asthma was
470,000.

See also the \"Association with Vulnerable Populations\" field.

#### EVIDENCE FOR UTILIZATION

Institute for Healthcare Improvement. Health Disparities Collaboratives
changing practice, changing lives: asthma training manual. Cambridge
(MA): Institute for Healthcare Improvement; 2002. 71 p.

#### COSTS

The total cost of asthma in 2000 was estimated to be \$12.7 billion,
with direct medical costs amounting to \$8.1 billion and lost earnings
due to illness and death totaling \$4.6 billion.

#### EVIDENCE FOR COSTS

Institute for Healthcare Improvement. Health Disparities Collaboratives
changing practice, changing lives: asthma training manual. Cambridge
(MA): Institute for Healthcare Improvement; 2002. 71 p.

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness\
Equity\
Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Total number of patients with asthma in the registry

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Total number of patients with asthma in the registry

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
The number of patients from the denominator evaluated for environmental
triggers other than environmental tobacco smoke (dust mites, cats, dogs,
molds/fungi, cockroaches) either by history of exposure and/or by
allergy testing

**Note**: The \"indoor\" environmental triggers here are those having
the strongest evidence of causal relationship to asthma.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Encounter or point in time

#### DATA SOURCE

Special or unique data

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison\
Prescriptive standard

#### PRESCRIPTIVE STANDARD

Goal: greater than 90%

#### EVIDENCE FOR PRESCRIPTIVE STANDARD

HDC topics: asthma. \[internet\]. Rockville (MD): HRSA Health
Disparities Collaboratives; 2005\[accessed 2005 Mar 31\]. \[8 p\].

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Evaluation of environmental triggers.

#### MEASURE COLLECTION

[HRSA Health Disparities Collaboratives
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1726&doc=6877)

#### MEASURE SET NAME

[HRSA HDC Asthma Collaborative
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1726&doc=6879)

#### SUBMITTER

Health Resources and Services Administration

#### DEVELOPER

HRSA Health Disparities Collaboratives: Asthma Collaborative

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Unspecified

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Unspecified

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2002 Jan

#### REVISION DATE

2003 Jan

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

HDC topics: asthma. \[internet\]. Rockville (MD): HRSA Health
Disparities Collaboratives; 2005\[accessed 2005 Mar 31\]. \[8 p\].

#### MEASURE AVAILABILITY

The individual measure \"Evaluation of Environmental Triggers,\" is
available from the [Health Disparities Collaboratives Web
site](http://www.healthdisparities.net/hdc/html/collaboratives.topics.asthma.aspx).

#### COMPANION DOCUMENTS

The following is available:

-   Institute for Healthcare Improvement. Health Disparities
    Collaboratives changing practice, changing lives: asthma training
    manual. Cambridge (MA): Institute for Healthcare Improvement; 2004.
    71 p.

#### NQMC STATUS

This NQMC summary was completed by ECRI on July 5, 2006. The information
was verified by the measure developer on August 18, 2006.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### Disclaimer

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008