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

Assumption:

Quality Result

Objectives:

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

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

ASTHMA APGAR

A=Activities P=Persistence G=triGGers A=Asthma Medications R=Response to Therapy

APGAR Results

A=Activities– 25%

% of patients with documented activity limits

APGAR Results

P=Persistence

– Day time symptoms 67%

% of patients with frequency of daytime symptoms documented

APGAR Results

P=Persistence

– Night time symptoms15%

% of patients with frequency of night time symptoms documented

The severity score addresses the baseline symptom

assessment:

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

APGAR Results

G=triGGers

– Are them mentioned or treated34%

% of patients with documented triggers

APGAR Results

A=Asthma medications– Prescribed medications

75% ? Percent that are really taking them that way

% of patients with prescribed medications documented and then actual medications

taken documented

APGAR Results

R=Response to therapy

– Did they get better or worse50%

% of patients with the response to therapy documented

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?

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