Joint Commission International Childrens Asthma Care (CAC) Measures

2010 Joint Commission International

I-CAC-1 Relievers for Childrens Inpatient Asthma

Measure Overview I-CAC-1 Relievers for Childrens Inpatient Asthma Overview/Details: Use of relievers in pediatric patients admitted for inpatient treatment of asthma Rationale: Asthma is the most common chronic disease in children and a major cause of morbidity and increased health care expenditures. For children, asthma is one of the most frequent reasons for admission to hospitals. Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. Clinical guidelines for the diagnosis and management of asthma in children, recommend the use of relievers to gain control of acute asthma exacerbation and reduce severity as quickly as possible, with step down medication to the least medication necessary to maintain control. Measure Related Outcomes: Mortality: Decreased mortality Readmissions within 30 days: Decreased Reliability: Increased delivery of evidence based care Improvement noted as: Increase in rate Patient Settings/Services Pediatric units Medical/Surgical units (serving pediatric patients) Free-standing Pediatric hospitals Measure Name: Relievers for Childrens Inpatient Asthma Numerator: Pediatric asthma inpatients who received relievers during this hospitalization. Denominator: Pediatric asthma inpatients (age 2 years through 17 years) who were discharged with a principal diagnosis of asthma

2010 Joint Commission International

Domains of Performance Appropriateness Availability Continuity Effectiveness Prevention/Early Detection Timeliness

QPS Standards QPS.3 patient assessments

CCPC Asthma

IPSG Goal 1

QPS.3 antibiotic and other medication use

2010 Joint Commission International

I-CAC-1
Measure Details Reasons and Implications: Clinical guidelines for the diagnosis and management of asthma in children, recommend the use of relievers to gain control of acute asthma exacerbation and reduce severity as quickly as possible, with step down medication to the least medication necessary to maintain control. Data Collection: Retrospective data sources for the required data elements include administrative data and medical records. Numerator: Pediatric asthma inpatients who received relievers during this hospitalization. Inclusions to the population: Patients who were administered relievers during this hospitalization. Exclusions to the population: None Data elements: Relievers Administered

Denominator: Pediatric asthma inpatients (age 2 years through 17 years) who were discharged with a principal diagnosis of asthma Data elements: Birthdate ICD Principal Diagnosis code Reason for Not Administering Relievers

Inclusions to the population: Discharges with: Patients with ICD principal diagnosis code of asthma as defined in Appendix A, Table 6.1 An age of 2 through 17 years

Exclusions to the population: Patients less than 2 years of age or greater than 18 years of age Patients with a documented Reason for Not Administering Relievers

2010 Joint Commission International

I-CAC-1

References Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P, Livingston JM, Weiss KB, and Weiss ST (2001). Use of Inhaled Anti-inflammatory Medication in Children with Asthma in Managed Care Settings. Archives of Pediatrics and Adolescent Medicine, 155, 501-507. Clinical Practice Guidelines of the American Academy of Pediatrics: A Compendium of Evidence-Based Research for Pediatric Practice. American Academy of Pediatrics, 1999. Crain EF, Weiss KB and Fagan MJ (1995). Pediatric Asthma Care in U.S. Emergency Departments. Archives of Pediatric and Adolescent Medicine. 149, 893-901. Gross KM, Ponte CD (1998). New Strategies in the Medical Management of Asthma. American Family Physician. 58:1 McCormick MC, Kass B, Elixhauser A, Thompson J and Simpson L (2000). Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States 1999. Pediatrics, 105:1, 219-230. Silber JH, Rosenbaum PR, Even-Shoshan O, Shabbout M, Zhang X, Bradlow ET, and Marsh RR (2003). Length of Stay, Conditional Length of Stay, and Prolonged Stay in Pediatric Asthma. Health Services Research, 38: 3, 867-886. Guidelines for the Diagnosis and Management of Asthma (EPR-3) (2007). http://www.nhlbi.nih.gov Asthma Management Model System, http://www.nhlbi.nih.gov National Asthma Education and Prevention Program, http://www.nhlbi.nih.gov

2010 Joint Commission International

I-CAC-1

Relievers for Childrens Inpatient Asthma

START

Run case included in CAC population (ICD Code for asthma)

ICD Code for asthma

NO

Case not in population

YES

Run case for population age 2 through 17 yeas old

Patient Age >= 2 through 17

NO

Case not in population

YES

Check if relievers administered

Relievers Administered

YES

Case in Numerator population

NO

Check if reason for not administering relievers

Reason for not administering relievers NO

YES

Case not in population

Determine Nominator / Denominator population

Case in Denominator population

2010 Joint Commission International

I-CAC-2 Systemic Corticosteroids for Children Inpatient Asthma

Measure Overview Systemic Corticosteroids for Children Inpatient Asthma Overview/Details: Use of systemic corticosteroids in pediatric patients admitted for inpatient treatment of asthma Rationale: Asthma is the most common chronic disease in children and a major cause of morbidity and increased health care expenditures nationally. For children, asthma is one of the most frequent reasons for admission to hospitals. Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. Clinical guidelines for the diagnosis and management of asthma in children, recommend the use of systemic corticosteroids to gain control of acute asthma exacerbation and reduce severity as quickly as possible, with step down medication to the least medication necessary to maintain control. Measure Related Outcomes: Mortality: Decreased mortality Readmissions within 30 days: Decreased Reliability: Increased delivery of evidence based care Improvement noted as: Increase in rate Patient Settings/Services Pediatric units Medical/Surgical units (serving pediatric patients) Free standing Pediatric hospitals Measure Name: Systemic corticosteroids for Childrens Inpatient Asthma Numerator: Pediatric asthma inpatients who received systemic corticosteroids during hospitalization. Denominator: Pediatric asthma inpatients (age 2 years through 17 years) who were discharged with a principal diagnosis of asthma

2010 Joint Commission International

Domains of Performance Appropriateness Availability Continuity Effectiveness Prevention/Early Detection Timeliness

QPS Standards QPS.3 patient assessments

CCPC Asthma

IPSG Goal 1

QPS.3 antibiotic and other medication use

2010 Joint Commission International

I-CAC-2
Measure Details Reasons and Implications: Clinical guidelines for the diagnosis and management of asthma in children, recommend the use of systemic corticosteroids to gain control of acute asthma exacerbation and reduce severity as quickly as possible, with step down medication to the least medication necessary to maintain control. Data Collection: Retrospective data sources for the required data elements include administrative data and medical records. Numerator: Pediatric asthma inpatients who received systemic corticosteroids during hospitalization. Inclusions to the population: Patients who were administered systemic corticosteroids during this hospitalization. Exclusions to the population: None Data elements: Systemic Corticosteroids Administered

Denominator: Pediatric asthma inpatients (age 2 years through 17 years) who were discharged with a principal diagnosis of asthma Data elements: Birthdate ICD Principal Diagnosis code Reason for Not Administering Systemic Corticosteroids

Inclusions to the population: Discharges with: Patients with ICD principal diagnosis code of asthma as defined in Appendix A, Table 6.1 An age of 2 years through 17 years

2010 Joint Commission International

Exclusions to the population: Patients less than 2 years of age or greater than 18 years of age Patients with a documented Reason for Not Administering systemic corticosteroids

2010 Joint Commission International

I-CAC-2

References Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P, Livingston JM, Weiss KB, and Weiss ST (2001). Use of Inhaled Anti-inflammatory Medication in Children with Asthma in Managed Care Settings. Archives of Pediatrics and Adolescent Medicine, 155, 501-507. Clinical Practice Guidelines of the American Academy of Pediatrics: A Compendium of Evidence-Based Research for Pediatric Practice. American Academy of Pediatrics, 1999. Crain EF, Weiss KB and Fagan MJ (1995). Pediatric Asthma Care in U.S. Emergency Departments. Archives of Pediatric and Adolescent Medicine. 149, 893-901. Gross KM, Ponte CD (1998). New Strategies in the Medical Management of Asthma. American Family Physician. 58:1 McCormick MC, Kass B, Elixhauser A, Thompson J and Simpson L (2000). Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States 1999. Pediatrics, 105:1, 219-230. Silber JH, Rosenbaum PR, Even-Shoshan O, Shabbout M, Zhang X, Bradlow ET, and Marsh RR (2003). Length of Stay, Conditional Length of Stay, and Prolonged Stay in Pediatric Asthma. Health Services Research, 38: 3, 867-886. Guidelines for the Diagnosis and Management of Asthma (EPR-3) (2007). http://www.nhlbi.nih.gov Asthma Management Model System, http://www.nhlbi.nih.gov National Asthma Education and Prevention Program, http://www.nhlbi.nih.gov

2010 Joint Commission International

I-CAC-2

Systemic corticosteroids for Childrens Inpatient Asthma

START

Run case included in CAC population (ICD Code for asthma)

ICD Code for asthma

NO

Case not in population

YES

Run case for population age 2 through 17 yeas old

Patient Age >= 2 through 17

NO

Case not in population

YES

Check if systemic corticosteroids were administered

Systemic Corticosteroids Administered

YES

Case in Numerator population

NO Check if reason for not administering systemic corticosteroids was documented

Reason for not Administering Systemic Corticosteroids NO

YES

Case not in population

Determine Numerator/ Denominator population

Case in Denominator population

2010 Joint Commission International

Appendix A ICD Codes

Please Note : Due to the various ICD Code versions used by different countries, ICD-8, ICD-9,and ICD-10 spaces have been left intentionally blank. Please fill in the specific code utilized by your country to correspond to the ICD-9-CM code description for the following diagnoses. Table 6.1 Asthma Codes
ICD-8 Code ICD-9 Code ICD-10 Code ICD-9CM Code Shortened Description

493.00 493.01 493.02 493.10 493.11 493.12 493.81 493.82 493.90 493.91 493.92

EXTRINSIC ASTHMA NOS EXT ASTHMA W STATUS ASTH EXT ASTHMA W(ACUTE) EXAC INTRINSIC ASTHMA NOS INT ASTHMA W STATUS ASTH INT ASTHMA W (AC) EXAC EXERCSE IND BRONCHOSPASM COUGH VARIANT ASTHMA ASTHMA NOS ASTHMA W STATUS ASTHMAT ASTHMA NOS W (AC) EXAC

2010 Joint Commission International