Children Asthma

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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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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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



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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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/


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START

ICD Code forasthma

Patient Age>= 2 through 17

RelieversAdministered

Reason for notadministering

relievers

YES

YES

NO

NO

Case not inpopulation


Case in Numeratorpopulation


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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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.




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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-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



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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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/


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START

ICD Code forasthma

Patient Age>= 2 through 17

Systemic

CorticosteroidsAdministered

Reason for not

Administering SystemicCorticosteroids

YES

YES

NO

NO



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

Children Asthma

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