Post on 05-Apr-2018
8/2/2019 Children Asthma
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2010 Joint Commission International
Joint Commission International
Childrens Asthma Care (CAC)
Measures
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2010 Joint Commission International
I-CAC-1Relievers 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 reasonsfor 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
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2010 Joint Commission International
Domains of Performance QPS Standards CCPC IPSG
Appropriateness
Availability
Continuity
Effectiveness
Prevention/Early Detection
Timeliness
QPS.3 patient
assessments
QPS.3 antibiotic and other
medication use
Asthma Goal 1
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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, Table6.1
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
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2010 Joint Commission International
I-CAC-1
References
Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P, Livingston JM, Weiss KB, and WeissST (2001). Use of Inhaled Anti-inflammatory Medication in Children with Asthma inManaged Care Settings. Archives of Pediatrics and Adolescent Medicine, 155, 501-507.
Clinical Practice Guidelines of the American Academy of Pediatrics: A Compendium ofEvidence-Based Research for Pediatric Practice. American Academy of Pediatrics, 1999.
Crain EF, Weiss KB and Fagan MJ (1995). Pediatric Asthma Care in U.S. EmergencyDepartments. 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 UnitedStates 1999. Pediatrics, 105:1, 219-230.
Silber JH, Rosenbaum PR, Even-Shoshan O, Shabbout M, Zhang X, Bradlow ET, andMarsh RR (2003). Length of Stay, Conditional Length of Stay, and Prolonged Stay inPediatric 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
http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/8/2/2019 Children Asthma
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2010 Joint Commission International
START
ICD Code forasthma
Patient Age>= 2 through 17
RelieversAdministered
Reason for notadministering
relievers
YES
YES
NO
NO
Case not inpopulation
Case not inpopulation
Case in Numeratorpopulation
Case not inpopulation
Case in Denominator
population
NO
NO
YES
YES
Run case included in CACpopulation (ICD Code for
asthma)
Run case for population age2 through 17 yeas old
Check if relieversadministered
Check if reason for not
administering relievers
Determine Nominator /Denominator population
I-CAC-1 Relievers for Childrens Inpatient Asthma
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2010 Joint Commission International
I-CAC-2Systemic 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 careImprovement 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
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2010 Joint Commission International
Domains of Performance QPS Standards CCPC IPSG
Appropriateness
Availability
Continuity
Effectiveness
Prevention/Early Detection
Timeliness
QPS.3 patient
assessments
QPS.3 antibiotic and
other medication use
Asthma Goal 1
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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, Table6.1
An age of 2 years through 17 years
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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
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I-CAC-2
References
Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P, Livingston JM, Weiss KB, and WeissST (2001). Use of Inhaled Anti-inflammatory Medication in Children with Asthma inManaged Care Settings. Archives of Pediatrics and Adolescent Medicine, 155, 501-507.
Clinical Practice Guidelines of the American Academy of Pediatrics: A Compendium ofEvidence-Based Research for Pediatric Practice. American Academy of Pediatrics, 1999.
Crain EF, Weiss KB and Fagan MJ (1995). Pediatric Asthma Care in U.S. EmergencyDepartments. 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). AnnualReport on Access to and Utilization of Health Care for Children and Youth in the UnitedStates 1999. Pediatrics, 105:1, 219-230.
Silber JH, Rosenbaum PR, Even-Shoshan O, Shabbout M, Zhang X, Bradlow ET, andMarsh RR (2003). Length of Stay, Conditional Length of Stay, and Prolonged Stay inPediatric 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
http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/http://www.nhlbi.nih.gov/8/2/2019 Children Asthma
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2010 Joint Commission International
START
ICD Code forasthma
Patient Age>= 2 through 17
Systemic
CorticosteroidsAdministered
Reason for not
Administering SystemicCorticosteroids
YES
YES
NO
NO
Case not inpopulation
Case not inpopulation
Case in Denominatorpopulation
NO
NO
YES
YES
Run case included in CACpopulation (ICD Code forasthma)
Run case for population age 2
through 17 yeas old
Check if systemiccorticosteroids were
administered
Check if reason for not
administering systemiccorticosteroids wasdocumented
Determine Numerator/Denominator population
I-CAC-2 Systemic corticosteroids for Childrens Inpatient Asthma
Case not in
population
Case in Numeratorpopulation
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Appendix
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 CodesICD-8
Code
ICD-9
Code
ICD-10
Code
ICD-9-
CM Code
Shortened Description
493.00 EXTRINSIC ASTHMA NOS
493.01 EXT ASTHMA W STATUS ASTH
493.02 EXT ASTHMA W(ACUTE) EXAC
493.10 INTRINSIC ASTHMA NOS
493.11 INT ASTHMA W STATUS ASTH
493.12 INT ASTHMA W (AC) EXAC
493.81 EXERCSE IND BRONCHOSPASM
493.82 COUGH VARIANT ASTHMA
493.90 ASTHMA NOS
493.91 ASTHMA W STATUS ASTHMAT
493.92 ASTHMA NOS W (AC) EXAC