Flunking asthma? When HEDIS takes the ACT.
OBJECTIVE
To test several patient-oriented asthma outcome measures and the Healthcare Effectiveness Data and Information Set (HEDIS) measure of appropriate medication for persistent asthma to determine the most useful quality indicator of asthma care.


METHODS
Prospective mail survey of adult employees and dependents with asthma.


METHODS
The medical and pharmacy claims of all subjects from 12 months before and after the survey were abstracted. Outcomes measures included the Asthma Control Test (ACT), workday loss, unscheduled healthcare utilization (emergency department and inpatient care), and satisfaction with care.


RESULTS
Although 81% of all responders had wellcontrolled asthma, persistent asthma was uncontrolled in 28%. Only 64.5% received appropriate controller medication. Well-controlled asthma is associated with a high degree of satisfaction, less workday loss, fewer prednisone bursts, and minimal unscheduled healthcare utilization. Except for a reduced incidence of more than 2 oral corticosteroid dispensings (6.4% vs 13.6%, P = .012), compliance with the HEDIS appropriate medication for asthma was not positively associated with any of the patient-centered outcomes studied.


CONCLUSIONS
Asthma control was the most useful patient outcome quality indicator in this study. Compliance with the HEDIS asthma measure in this population was not associated with a better patient-oriented outcome. This finding may be different with different levels of asthma control. The positive association between well-controlled asthma and patient satisfaction, minimal unscheduled healthcare utilization, and low workday loss suggests that asthma control as measured by ACT may be a better performance measure in asthma.
Lim
Kaiser G
KG
Division of Pulmonary and Critical Care Medicine (E18), Mayo Clinic, Bldg E 18, 200 First St SW, Rochester, MN 55905, USA. lim.kaiser@mayo.edu
Patel
Ashok M
AM
Naessens
James M
JM
Li
James T
JT
Volcheck
Gerald W
GW
Wagie
Amy E
AE
Enders
Felicity B
FB
Beebe
Timothy J
TJ
D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D002908:Chronic Disease; D019468:Disease Management; D004526:Efficiency; D005260:Female; D006123:Group Practice; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D016272:Occupational Health / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010349:Patient Compliance; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires