Summary

Health care in America is plagued by extensive gaps in quality. Too often care provided to patients does not match what the medical community has determined to be the most effective care. Abundant research has shown that these gaps in quality are responsible for increased costs, wasteful and ineffective care, preventable complications, avoidable hospitalizations, decreased quality of life, disability, and premature death.

The National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR), published annually by AHRQ since 2003, provide both extensive research and data on the extent of health care quality gaps as well as national benchmarks for quality. This Resource Guide and its accompanying Workbook draw on the NHQR and the NHDR to support State-level efforts to improve the quality of asthma care.

This Resource Guide is designed to help State leaders identify measures of asthma care quality, assemble data on asthma care, assess areas of care most in need of improvement, and learn what other States have done to improve asthma care. Taken together, the Resource Guide and its companion Workbook can help State leaders to develop an asthma quality improvement action strategy.

Why Asthma?

Asthma is a chronic lung condition that impairs normal breathing. The disease affects a growing number of Americans. In 2007, 16.2 million adults and 6.7 million children stated they currently had asthma (Pleis and Lucas, 2009). Asthma is also costly: total estimated costs in 2007 were $19.7 billion (American Lung Association [ALA], 2009).

For several reasons, asthma presents an opportune target for quality improvement:

• Increased prevalence, especially among children and adolescents.
• Disparities between socioeconomic groups and between racial/ethnic groups in terms of diagnoses and quality of asthma care.
• A range of interventions and treatment that can successfully control the disease and prevent attacks.
• High health care costs of uncontrolled asthma and the potential for a positive return on investment for purchasers and the health care system as a whole through asthma quality improvement.

Improved quality of asthma care may help to cut costs, reduce disparities, and improve the quality of life for millions of people with asthma.

A State-Led Framework for Improving Asthma Quality of Care

The Resource Guide introduces a framework for improving health care quality at the State level. States have typically viewed their role in quality improvement from a public health perspective or, more narrowly, as a buyer of health insurance for State employees. However, States can play a more comprehensive leadership role. Some States are already doing this, at least in part, with respect to asthma.

This approach envisions three central roles for States in quality improvement:

• Provide leadership—Entails providing a defining vision for change, setting goals, and providing an environment that fosters improvement.
• Work in partnership—Involves creating a committed partnership of stakeholders dedicated to identifying, proposing, and testing solutions and developing plans for improvement.
• Implement improvement—Means implementing changes, measuring and analyzing the results of changes, and applying successful improvements on a broader scale.

Learning From Current State Quality Improvement Efforts

Many States have already begun programs or demonstrations to improve the quality of asthma care. These actions can inform broader efforts within the State or the efforts of other States. This Resource Guide identifies a broad range of current asthma quality improvement activities, including public-private coalitions, cross-agency initiatives, data measurement and reporting projects, disease management training, and educational outreach programs for minority and rural populations.

Measuring the Quality of Asthma Care

Assessing State quality of care for asthma requires good data and useful measures. Useful quality measures include process measures, which reflect the quality of care delivered, and outcome measures, which reflect patient health status. The former can guide health care providers on how to change while the latter can gauge whether the changed processes have had the intended effect.

The NHQR provides a starting point for accessing consensus-based measures. The NHQR provides estimates for asthma hospitalizations by State. In addition, this Resource Guide incorporates estimates from the Behavioral Risk Factor Surveillance System to assess asthma care quality by State. Although a consensus on a few key measures of asthma care quality has not yet evolved, an inventory of the many measures available is provided.

Data are also essential to improve quality. States need performance data on asthma care to assess their own performance against national benchmarks and to focus quality improvement efforts by identifying potential problem areas. A list of national, State, and local sources for estimates for asthma, asthma care, and other related information is also included.

Moving Ahead: Implications for State Action

Identifying measures and data sources is only a first step. As part of a systematic initiative to improve the quality of asthma care, States will need to bundle these resources into a comprehensive, State-specific picture of asthma care that identifies areas for improvement and provides a basis for planning among the partners. This picture may require collecting specific data on asthma care that focus on a State's health care systems. Doing so will enable States to identify specific quality problems in their own communities, tailor specific solutions, and assess the effectiveness of specific interventions.

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