PTE Pediatric Asthma Metrics Reporting Updated January 2015

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1 PTE Pediatric Asthma Metrics Reporting Updated January 20 Introduction: The Maine Health Management Coalition s (MHMC) Pathways to Excellence (PTE) Program is preparing for its next round of PTE Pediatric Asthma Metric updates. Practices submitting new or updated data on these measures by Friday, February 27, 20 will be included in the April 1, 20 GetBetterMaine website update. SUBMISSION INSTRUCTIONS: 1. Complete form and have responsible provider sign (form below is only an example, if submitting, please use the form found here: under Asthma entitled Excel Worksheet for Calculating Practice Rates on PTE Pediatric Asthma Metrics ). 2. Send to the Maine Health Management Coalition either by fax, or scan and a. Fax: b. to (preferred) 3. If possible, practice reports from registry or EMR. If none of these choices are available, then a chart review can be done. Note: There must be a minimum of 10 patient charts reviewed for ages 2<5 and 20 patient charts reviewed for ages 5< 19 (a total of at least 30 charts). 4. Practice agrees to participate in an on-site validation of the data, upon the MHMC s request. 5. Recognition will be effective for 2 years from the date of submission and the practice agrees to be publically reported on the GetBetterMaine reporting website. 6. Practices who do not meet the lowest level of scoring criteria (<45 points) will be notified and reported as Did Not Report on the aforementioned reporting website. These practices can resubmit data quarterly to participate in the reporting or to improve their ratings (practices who currently have the PTE Good or Better rating may resubmit for a higher rating prior to their expiration date).

2 **BELOW IS AN EXAMPLE ONLY** FOR SUBMISSION, PLEASE USE THE EXCEL SHEET FOUND AT THE LINK DESCRIBED IN ITEM #1 ABOVE Practice Name: Date: Practice Address: Date: Person Completing: Responsible Clinician: Phone: Signature: PTE Pediatric Asthma Metrics and Scoring Asthma Measures NUMER- ATOR DENOMINATOR (Note: for practices doing manual chart review, must be > 10 charts for ages 2<5 and > 20 charts for ages 5<19 Practice Rate Max Points for Measure 1. Asthma Assessment 2. Lung Function Testing (Note: Ages 5<19) 3. Medication Therapy 4. Influenza Vaccination 5. Patient Self Management Plan 6 Documented Tobacco Exposure/Use 7. BMI % 10 Sub-Total Points Available/Received Population Based Reporting-EMR/Registry for all asthmatics? Yes/No Yes = 10 No = 0 Total points for Population-Based reporting (if applicable) Practice Points Achieved(Practice Rate multiplied by Maximum Points Available)* * The points for each category are rounded to the next whole number. ** Best is only achievable for those reporting their total population regardless of the final score. MHMC Rating (Good, Better, Best) Good > 45 Points; Better > 65 Points; ** Best > 75 Points January 20 2

3 The PTE Clinicians Steering Committee recognizes that lung function testing has not been utilized as much as NHLBI guidelines recommend. Therefore, accommodations in scoring were made to allow practices to obtain the best rating in 2013 while working to bring their lung function testing rates up to guidelines. (See Sample Scoring Below). PTE Pediatric Asthma Metrics and Scoring Example from Chart Submission Asthma Measures 1. Asthma Assessment 2. Lung Function Testing (Note: Ages 5<19) 3. Medication Therapy 4. Influenza Vaccination 5. Patient Self-Management Plan 6 Documented Tobacco Exposure/Use 7. BMI % NUMER- ATOR DENOMINATOR (Note: for practices doing manual chart review, must be > 10 charts for ages 2<5 and > 20 charts for ages 5<19 Practice Rate Max Points for Measure Practice Points Achieved(Practice Rate multiplied by Maximum Points Available)* % % % % % % % 10 9 Sub-Total Points Available/Received Population Based Reporting-EMR/Registry for all asthmatics? Yes/No Yes = 10 No = 0 Total points for Population-Based reporting (if applicable) 76 * The points for each category are rounded to the next whole number. ** Best is only achievable for those reporting their total population regardless of the final score. MHMC Rating (Good, Better, Best) Good > 45 Points; Better > 65 Points; ** Best > 75 Points 0 January 20 3

4 INCLUSION CRITERIA An eligible asthma patient is one who meets all three of the following criteria: 1. Is between the ages of 2 and <19 years of age on the last day of the reporting period. 2. Has been under the care of. This is defined as at least two face-toface office visits with a physician, physician's assistant, or nurse practitioner with one visit in each measurement year. (Encounter CPT codes: , , , , and ) 3. Patient has a documented diagnosis of asthma (ICD-9 Dx Codes: , , , , and ) (Above Criteria is from the American Medical Association Measure Steward guidance on ASTHMA: Algorithm for Measure Calculation-EHRS [Analytic Narrative and Data Elements]) 4. Include all patients regardless of payer (e.g. commercial, Medicare, Medicaid, self-pay, uninsured, etc.). 5. Practices can include patients that are primarily managed by subspecialists for asthma in their data set. 6. Providers should clinically verify that all the patients meet the National Heart, Lung, and Blood Institute (NHLBI) definition for asthma (as defined in "Definitions" in specifications document). 7. Practices are encouraged to submit population based data on all patients that meet criteria in their practice. Only practices that submit population data from EHR, registry or claims can attain a "best" rating. Practices that are doing chart review will be expected to submit data on at least 30 patients. (10 for ages 2 <5 and 20 for ages 5< 19.) If this minimum is not met for your practice, please include an explanation with your submission materials. January 20 4

5 Maine Health Management Coalition Pathways to Excellence: Asthma Measure Specifications # Measure Name PTE Measure Description and Numerator (N)/Denominator (D) 1 Asthma Assessment i : % of Numerator: Total number of children 2<19 yo patients with diagnosis of with a diagnosis of asthma who were evaluated asthma ages 2 and <19, within 12 mo for the frequency (numeric) of who were evaluated during daytime and nocturnal asthma symptoms. at least one office visit within 12 months for daytime and nocturnal asthma symptoms. 2 Lung Function Testing ii : % of patients with diagnosis of asthma ages 5 and <19 yo in which one or more spirometry result(s) have been obtained within the past 24 months 3 Medication Therapy iii : % of patients ages 2 and <19 yo who were identified as having persistent asthma and were appropriately prescribed controller medication 4 Influenza Vaccination iv : % of patients with diagnosis of asthma ages 2 and <19 yo who have a documented flu shot within the past 12 mo Numerator: Number of patients 5 <19 yo who have had spirometry completed at least once in the last 24 mo. Denominator: Patients between the ages of 5 Numerator: Total number of patients age 2<19 identified with persistent asthma who were appropriately prescribed controller medication within the last 12 mo. and have a documented diagnosis of persistent asthma. Numerator: Total number of patients ages 2<19 yo with flu shot documented within the last 12 mo Criteria For asthma control tests, these tools are validated: Test for Respiratory and Asthma Control in Kids TRACK 2 < 4 years of age, and Asthma Control Test ACT 4 years of age Will need to document that some children are physically unable to perform test Moderate or Severe Persistent Asthmatics may need to have lung function testing done more frequently than every 2 years; this metric will capture that all asthmatics should have lung function testing at least every 2 years Need to document contraindications (included in BTE metric) ACIP: Recommends influenza vaccination for all >6 months and when supply is limited focus on those with chronic pulmonary disease (including asthma), among others. January 20 5

6 5 Patient Self-Management Numerator: Number of patients 2<19 yo with a Plan v : written action plan updated within the last 12 % of patients with diagnosis mo. of asthma ages 2 and <19 yo, that have a current written action plan on file updated within the last year An asthma action plan (also called a management plan) is a written plan that is developed by a provider with a family that outlines a patient s medical therapy and asthma symptoms that warrant further treatment or action 6 Tobacco Exposure and Use: % of patients with diagnosis of asthma ages 2 and <19 yo with annual documentation of tobacco exposure/ tobacco use 7 BMI % vi : % patients % of patients with diagnosis of asthma ages 2 and <19 yo with BMI% documented Numerator: Total number of children ages 2 and <19 yo with documentation of tobacco exposure and for children ages 10 and <19 assessed for tobacco use within the last 12 mo. Numerator: Patients 2<19yo who have evidence of Body Mass Index (BMI) percentile documentation within the last 12 mo. and have a documented diagnosis of asthma Tobacco exposure is defined as someone who uses tobacco who lives in the household or is a primary caregiver. i Adapt Meaningful use, NQF #001, AMA (Currently ages 5-40) ii Adapt BTE Lung Function and Spirometry Metric (Currently ages 5-75 and yearly evaluation) NHLBI 2007 Guidelines: The Expert Panel recommends the following frequencies for spirometry measurements: (1) at the time of initial assessment (Evidence C); (2) after treatment is initiated and symptoms and PEF have stabilized, to document attainment of (near) normal airway function; (3) during a period of progressive or prolonged loss of asthma control; and (4) at least every 1 2 years to assess the maintenance of airway function (Evidence B, extrapolation from clinical trials). Spirometry may be indicated more often than every 1 2 years, depending on the clinical severity and response to management (Evidence D). These spirometry measures should be followed over the patient s lifetime to detect potential for decline and rate of decline of pulmonary function over time (Evidence C). iii Adapt Meaningful use /NQF #0036 (Currently ages 5-11, 12-50) iv Adapt BTE Influenza Vaccination Metric (Currently ages 5-75 years) v Adapt BTE Patient Self-Management Plan Metric (Currently ages 5-75 years) vi Adapt BTE Body Mass Index Metric (Currently Percentage of patients ages 18-75) January 20 6

7 DEFINITIONS Asthma: To establish a diagnosis of asthma, the clinician should: - Use a medical history and exam to determine that symptoms of variable and recurrent episodes of airflow obstruction, airway hyper responsiveness, and underlying inflammation are present. In susceptible individuals, this inflammation causes recurrent episodes of coughing (particularly at night or early in the morning), wheezing, breathlessness, and chest tightness. (Source: p. 9 of Abridged NHLBI Guidelines) - Use spirometry in all patients 5 years or greater to determine the level of airflow obstruction and assess reversibility - Exclude alternative diagnoses (Upper Airway Disease- allergic rhinitis and sinusitis; Obstruction of the large airways: foreign body in trachea or bronchus, vocal cord dysfunction, vascular ring or laryngeal web, laryngotracheomalacia, tracheal stenosis, or broncheostenosis, enlarged lymph node or tumor; Obstructions involving small airways: viral bronchiolitis or obliterative bronchiolitis, cystic fibrosis, bronchopulmonary dysplasia, heart disease; Other causes: recurrent cough not due to asthma, aspiration from swallowing mechanism dysfunction or gastroesophageal reflux) (Source: Differential Diagnosis for Asthma, AH! Program Flipchart, p. 3) Persistent Asthma: - Symptoms >2 days per week OR - Awaken at night from asthma 1-2X per month for children ages 2 <5 years and >2X per month ages 5 <19 years OR - Limitation of activities, despite pretreatment for exercise induced asthma OR - More than 2 steroid bursts in 1 year OR - FEV1 <80% predicted OR low FEV1/FVC ratio January 20 7

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