Assessing quality of asthma care in your practice-- The Asthma APGAR

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Assessing quality of asthma care in your
practice--The Asthma APGAR

• Barbara P. Yawn, MD, MSc
• Director of Research
• Olmsted Medical Center
• Rochester, MN USA
• February 20, 2004
• Melbourne, Australia

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Assumption
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Objectives

• Identify quality related outcomes
• Suggest quality indicators
• Develop process to assess indicators
• Use indicators to modify practice

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Quality should focus on

• Outcomes that matter to patients
• Outcomes that matter to families
• Outcomes that matter to clinicians
• Outcomes that matter to quality monitors

In that order
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ASTHMA APGAR

• AActivities
• PPersistence
• GtriGGers
• AAsthma Medications
• RResponse to Therapy

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APGAR Results

• AActivities
• 25

of patients with documented activity limits
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APGAR Results

• PPersistence
• Day time symptoms
• 67

of patients with frequency of daytime symptoms
documented
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APGAR Results

• PPersistence
• Night time symptoms
• 15

of patients with frequency of night time
symptoms documented
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The severity score addresses the baseline symptom
assessment

• Does not address the asthma that is being treated
  nor does it consider attacks

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APGAR Results

• GtriGGers
• Are them mentioned or treated
• 34

of patients with documented triggers
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APGAR Results

• AAsthma medications
• Prescribed medications
• 75
• ? Percent that are really taking them that way

of patients with prescribed medications
documented and then actual medications taken
documented
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APGAR Results

• RResponse to therapy
• Did they get better or worse
• 50

of patients with the response to therapy
documented
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GAPS?

• Your impressions of the data ?
• What is currently working well?
• Why is it working well?
• What would you like to improve?
• Systems that you want to change?

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Solutions

• A patient asthma APGAR
• Ask the nurse to give patient the APGAR to
  complete
• Develop patient expectations so that they give
  you their APGAR
• Use as a control score