- Email: [email protected]
P129 Real-world evaluation of the hedis medication management for people with asthma measure
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124
S59
P129 REAL-WORLD EVALUATION OF THE HEDIS MEDICATION MANAGEMENT FOR PEOPLE WITH ASTHMA MEASURE S. Desai*1, W. Crawford2, J. Sheikh3, 1. Anaheim, CA; 2. Redondo Beach, CA; 3. Los Angeles, CA. Background: The Healthcare Effectiveness Data and Information Set (HEDIS) is an asthma quality of care measure that is designed to quantify patient adherence to asthma controller medication, but its true utility in asthma outcomes is unclear. Objective: Establish whether the HEDIS Medication Management for People with Asthma (MMA) measure is associated with improved asthma outcomes. Methods: Administrative data identified 18,554 patients (13,529 adults, 5,025 children) who met HEDIS criteria for persistent asthma during 2013. These patients were classified as compliant or non-compliant with the MMA measure at the >75%, 50-75% and <50% thresholds and asthma outcomes in those years were determined. Results: Adult patients showed no significant difference in hospitalizations or oral corticosteroid prescriptions in 2012-2014. There was no significant difference in SABA use in 2012, and a slightly increased use in the >75% compliant group in 2013 and 2014. The <50% compliant group had more ED visits in 2012-2014 than the other groups. Children who were <50% compliant in 2012-2013 had some increased ED visits, but there was no difference in 2014. There was no significant difference in hospitalizations 2012-2013, and a slight increase in the 75% group that was statistically but not likely clinically significant. There was no difference in SABA use in 20122014. Oral steroid prescriptions were the same in 2012 and 2014, and slightly increased in the 75% group in 2013. Conclusion: Compliance with the HEDIS MMA measure does not appear to be related to improvement in hospitalizations and oral corticosteroid use when assessed over 3-years.
P130 QUALITY METRICS IN ASTHMA: A CLINICAL REVIEW T. Miller*, M. Albrecht, Roseville, CA. Introduction: Quality in healthcare is determined by providing the most proficient care to every patient in order to obtain the best possible outcomes. Quality measures in asthma have been previously established, but are yet to be routinely used. With asthma prevalence at elevated levels, quality measures are believed to help healthcare professionals better understand the needs of asthma patients and therefore be more equipped to prevent and manage the effects of the disease. We sought to perform a systemic review and analysis of the implementation of quality measures in asthma patients within our practice. Methods: A retrospective audit of charts was performed to evaluate patients with asthma between July 1, 2015 and December 31, 2015. 233 charts were selected by protocol through the electronic healthcare database. 107 (45.92%) of the 233 charts were identified with asthma diagnosis and were included in this study. Performance assessment of 1) symptom control, 2) air flow evaluation, 3) patient education, 4) asthma action plan, 5) controller and 6) rescue medications prescriptions, 7) immunization status, 8) tobacco exposure, and 9) follow up appointments was conducted. Results: Each of the performance tools that were measured were utilized above 80%, with the exception of immunization status. Some quality metrics approached or exceeded 90% implementation (air flow assessment, patient education, asthma action plan, inhaler prescriptions, and tobacco assessment). Conclusion: Quality measures can be performed in an airway/ respiratory focused setting. In addition, these quality metrics were assessed simultaneously at each patient visit. Further research is necessary to determine if broad application is feasible.
Overview of each performance test evaluated in office
P131 CLINICIAN KNOWLEDGE, CONFIDENCE, AND NEED FOR EDUCATION IN SEVERE ASTHMA MANAGEMENT D. LaTemple*1, J. Simmons1, B. Bixler2, A. Fitzpatrick3, L. Rogers4, E. Bleecker5, 1. Malvern, PA; 2. Hershey, PA; 3. Atlanta, GA; 4. New York, NY; 5. Winston-Salem, NC. Introduction: Treatment of severe asthma increasingly relies on phenotypic characterization that can influence choice of nonspecific and/or targeted therapy. As severe asthma represents 10% of patients, clinicians may be unfamiliar with the phenotypes and heterogeneity of disease subtypes and/or advances in targeted therapy. To help physicians differentiate severe from uncontrolled asthma and develop treatments based on phenotypic characterization, a five-course e-learning CME curriculum was developed. Methods: Using pre/postsurveys, the activities assessed changes in knowledge, confidence, and frequency of use of strategies highlighted in the activities. Activities were distributed to U.S. practicing pulmonologists, allergists/immunologists, and primary care physicians and were active for one year. Data were reported as percent change (pre to post). Paired data were analyzed using Student’s t-test. Results: Of 220 physician participants, 61% reported >25 years in practice, 60% saw 10 patients/week with severe asthma, and 35% were allergy/immunology specialists. Physician mean confidence improved from baseline across all activities, including recognizing poorly controlled asthma (13%; range 9%e16%), identifying severe asthma (25%; 15%e38%), and developing targeted treatment plans (57%; 54%e60%). Mean improvements from baseline also were observed in planned use of determining patient adherence (21%; 6%e40%), classifying asthma by phenotype 29%, and optimal use of targeted therapy (58%; 56%e60%). Overall, physician mean knowledge improved by 79% (4%e270%). Conclusion: Confidence and intent-to-change improvements from these activities indicate a continuing need for education on clinical strategies for differentiating between severe asthma (phenotype) and poorly controlled asthma. This distinction is highly relevant in the current age of new, targeted therapies.
P132 INFLUENZA VACCINATION RATES AMONG CHILDREN WITH ASTHMA D. Patadia*, D. Stukus, Columbus, OH. Introduction: Annual influenza vaccination is recommended for children with asthma due to increased risk for complications with acute infection. There is a lack of data regarding annual influenza vaccination rates, particularly among inner city children with asthma. Methods: We performed a retrospective review of the electronic medical record of children ages 2-18 years seen in the primary care
S59
P129 REAL-WORLD EVALUATION OF THE HEDIS MEDICATION MANAGEMENT FOR PEOPLE WITH ASTHMA MEASURE S. Desai*1, W. Crawford2, J. Sheikh3, 1. Anaheim, CA; 2. Redondo Beach, CA; 3. Los Angeles, CA. Background: The Healthcare Effectiveness Data and Information Set (HEDIS) is an asthma quality of care measure that is designed to quantify patient adherence to asthma controller medication, but its true utility in asthma outcomes is unclear. Objective: Establish whether the HEDIS Medication Management for People with Asthma (MMA) measure is associated with improved asthma outcomes. Methods: Administrative data identified 18,554 patients (13,529 adults, 5,025 children) who met HEDIS criteria for persistent asthma during 2013. These patients were classified as compliant or non-compliant with the MMA measure at the >75%, 50-75% and <50% thresholds and asthma outcomes in those years were determined. Results: Adult patients showed no significant difference in hospitalizations or oral corticosteroid prescriptions in 2012-2014. There was no significant difference in SABA use in 2012, and a slightly increased use in the >75% compliant group in 2013 and 2014. The <50% compliant group had more ED visits in 2012-2014 than the other groups. Children who were <50% compliant in 2012-2013 had some increased ED visits, but there was no difference in 2014. There was no significant difference in hospitalizations 2012-2013, and a slight increase in the 75% group that was statistically but not likely clinically significant. There was no difference in SABA use in 20122014. Oral steroid prescriptions were the same in 2012 and 2014, and slightly increased in the 75% group in 2013. Conclusion: Compliance with the HEDIS MMA measure does not appear to be related to improvement in hospitalizations and oral corticosteroid use when assessed over 3-years.
P130 QUALITY METRICS IN ASTHMA: A CLINICAL REVIEW T. Miller*, M. Albrecht, Roseville, CA. Introduction: Quality in healthcare is determined by providing the most proficient care to every patient in order to obtain the best possible outcomes. Quality measures in asthma have been previously established, but are yet to be routinely used. With asthma prevalence at elevated levels, quality measures are believed to help healthcare professionals better understand the needs of asthma patients and therefore be more equipped to prevent and manage the effects of the disease. We sought to perform a systemic review and analysis of the implementation of quality measures in asthma patients within our practice. Methods: A retrospective audit of charts was performed to evaluate patients with asthma between July 1, 2015 and December 31, 2015. 233 charts were selected by protocol through the electronic healthcare database. 107 (45.92%) of the 233 charts were identified with asthma diagnosis and were included in this study. Performance assessment of 1) symptom control, 2) air flow evaluation, 3) patient education, 4) asthma action plan, 5) controller and 6) rescue medications prescriptions, 7) immunization status, 8) tobacco exposure, and 9) follow up appointments was conducted. Results: Each of the performance tools that were measured were utilized above 80%, with the exception of immunization status. Some quality metrics approached or exceeded 90% implementation (air flow assessment, patient education, asthma action plan, inhaler prescriptions, and tobacco assessment). Conclusion: Quality measures can be performed in an airway/ respiratory focused setting. In addition, these quality metrics were assessed simultaneously at each patient visit. Further research is necessary to determine if broad application is feasible.
Overview of each performance test evaluated in office
P131 CLINICIAN KNOWLEDGE, CONFIDENCE, AND NEED FOR EDUCATION IN SEVERE ASTHMA MANAGEMENT D. LaTemple*1, J. Simmons1, B. Bixler2, A. Fitzpatrick3, L. Rogers4, E. Bleecker5, 1. Malvern, PA; 2. Hershey, PA; 3. Atlanta, GA; 4. New York, NY; 5. Winston-Salem, NC. Introduction: Treatment of severe asthma increasingly relies on phenotypic characterization that can influence choice of nonspecific and/or targeted therapy. As severe asthma represents 10% of patients, clinicians may be unfamiliar with the phenotypes and heterogeneity of disease subtypes and/or advances in targeted therapy. To help physicians differentiate severe from uncontrolled asthma and develop treatments based on phenotypic characterization, a five-course e-learning CME curriculum was developed. Methods: Using pre/postsurveys, the activities assessed changes in knowledge, confidence, and frequency of use of strategies highlighted in the activities. Activities were distributed to U.S. practicing pulmonologists, allergists/immunologists, and primary care physicians and were active for one year. Data were reported as percent change (pre to post). Paired data were analyzed using Student’s t-test. Results: Of 220 physician participants, 61% reported >25 years in practice, 60% saw 10 patients/week with severe asthma, and 35% were allergy/immunology specialists. Physician mean confidence improved from baseline across all activities, including recognizing poorly controlled asthma (13%; range 9%e16%), identifying severe asthma (25%; 15%e38%), and developing targeted treatment plans (57%; 54%e60%). Mean improvements from baseline also were observed in planned use of determining patient adherence (21%; 6%e40%), classifying asthma by phenotype 29%, and optimal use of targeted therapy (58%; 56%e60%). Overall, physician mean knowledge improved by 79% (4%e270%). Conclusion: Confidence and intent-to-change improvements from these activities indicate a continuing need for education on clinical strategies for differentiating between severe asthma (phenotype) and poorly controlled asthma. This distinction is highly relevant in the current age of new, targeted therapies.
P132 INFLUENZA VACCINATION RATES AMONG CHILDREN WITH ASTHMA D. Patadia*, D. Stukus, Columbus, OH. Introduction: Annual influenza vaccination is recommended for children with asthma due to increased risk for complications with acute infection. There is a lack of data regarding annual influenza vaccination rates, particularly among inner city children with asthma. Methods: We performed a retrospective review of the electronic medical record of children ages 2-18 years seen in the primary care