Overview
Approximately 6.2 million children under the age of 18 have been diagnosed with asthma. Of that number, 3.5 million have suffered from an asthma attack or episode. Uncontrolled asthma can result in chronic lingering symptoms, permanent lung damage, unnecessary emergency room visits, hospitalizations and even death. This guide offers the necessary tools to treat pediatric asthma effectively through evidence-based care.
Breathing Easy…or Missing the Mark?
Too often, children with asthma aren’t given tests and action plans that are proven to keep them healthy and safe.
Asthma is … the No. 1 chronic disease facing children in your service area. Asthma is a complex chronic disease with a great deal of variability in cost and treatment. It tends to be a lifelong condition. Asthma can be overlooked during regular visits if a child isn’t presenting obvious difficulty.
Only about HALF of children with asthma are following quality guidelines.
National research has shown that only about 1/2 of pediatric patients with asthma are following quality guidelines that recommend using longterm controller medications daily, having written action plans for managing asthma attacks, and conducting regular asthma control testing.
More than HALF of children with asthma will have at least one attack in a given year and suffer from uncontrolled asthma.
Let’s work together to improve pediatric asthma management.
Make control testing for asthma a priority during well-child visits. This is often a missed opportunity to understand a child’s asthma diagnosis.
Take a closer look.
Ask the right questions to accurately assess patient risks.
Create an outreach list for all patients in your practice with asthma who have not been tested or do not have a current asthma action plan.
Get the shot. Make sure all asthma patients receive an annual flu shot.
The Vanderbilt Health Affiliated Network’s Quality Measures Toolkit provides useful tools and resources to help practices improve quality measures, close clinical gaps and advance patient care. For more information, please visit VHANhub.com.
The Network Why
One important way VHAN members optimize patient care is by sharing evidence-based care strategies and clinical best practices with their peers. VHAN’s team-based approach, following the patient-centered medical home (PCMH) model, encourages all clinic personnel to work together to effectively deliver patient-centered asthma management and care. Members of an asthma care team include doctors, nurses, physician assistants, specialists and other non-clinical professionals. Patients with chronic conditions often visit a primary care physician and a specialist, and they may encounter several other providers when seeing after-hours or emergency care. Aligning these primary and specialty care services can improve patient care and improve the patient experience. A collaborative approach helps ensure seamless communication, an improved referral process and better transitions among healthcare staff.
VHAN providers can use this guide to more reliably coordinate care delivery, resulting in improved quality and a better experience for patients and their families.
Shared Savings Impact
The network’s Pediatric Clinical Advisory Committee (PCAC) defines asthma performance as part of the pediatric modifier. VHAN members all share the responsibility for quality and cost goals, with improving performance around pediatric asthma one of the contributing factors to reaching these goals. Proper asthma control for pediatric and adult patients is a quality measure for major VHAN contracts, such as United ACO, Aetna and Cigna. Uncontrolled asthma also has the strong potential of affecting ED utilization and readmission rates, which can adversely impact shared savings. However, the payoff of better asthma control is not just financial. By placing the focus on proper asthma care and treatment, we are also sharing in better patient outcomes, improved satisfaction for providers and their teams, and verifiable health improvements across our state and region.
The payoff of better asthma control is not just financial. Together, we are making a collective impact on the communities we call home.
Improve Your Modifier
To ensure our pediatric patients are receiving preventive care that will help reduce the need for hospital visits, decrease unnecessary ED utilization and improve quality of life, VHAN has been recording pediatric asthma quality measures since 2012. National Institutes of Health (NIH) guidelines suggest persistent asthma patients be seen several times a year.
Quality metrics to code for each patient within the measurement year:
- Two Asthma Control Tests (ACT) (CPT 96160)
- A flu shot for all patients with an asthma diagnosis
- VHAN Asthma Education Attendance
These metrics apply to patients …
□ Age 4 years and older
□ Aetna, United Healthcare or Cigna insurance*
□ At least one diagnosis of persistent asthma
The timeframe looks back a rolling 12 months.
*Although gap reports and shared savings apply only to Aetna, United Healthcare and Cigna patients at this time, practices are encouraged to incorporate these measures into workflows for all of their persistent asthma patients.
United Healthcare also includes a contracted Quality Measure for AMR Asthma Medication Ratio, detailed below:
Numerator:
Patients ages 5–64 identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.50 or greater during the measurement year
- Denominator:
Patients ages 5–64 identified as having persistent asthma Exclusions: - Members who weren’t prescribed an asthma medication
- Members who use hospice services or elect to use a hospice benefit, regardless of when the services began in the measurement year or if patients have any of the following diagnosis:
Acute respiratory failure, chronic obstructive pulmonary disease (COPD), chronic respiratory conditions due to fumes/vapors, cystic fibrosis, emphysema, obstructive chronic bronchitis, or other emphysema any time during a member’s history through Dec. 31 of the measurement year
For additional detail on the current modifier and quality score details, visit https://vhanhub.com/tool-kits/quality-measures/quality-measures-other-resources.
VHAN Resources and Support
VHAN has several resources for practices that need assistance with pediatric asthma management.
1. Take Advantage of Your VHAN Team
Our pediatric team, Network Operations Directors and Network Operations Managers are available to consult on ways to enhance your processes and workflow. They may recommend ongoing learning opportunities for your practice’s needs.
To connect with your VHAN team and ensure your processes are as efficient as possible, contact your Population Health Associate: Beverly Puckett | beverly.j.puckett@vhan.com
2. Utilize the Available Data and Analytics
As of January 2021, VHAN pediatric practices now have access to quarterly dashboards. Providers can view all their patients who were sent to the ED or hospitalized with asthma in the previous six months. Use this data to follow up with these patients to discuss the possible triggers and any necessary changes in treatment.
How do the dashboards differ from the monthly Quality Measure reports?
The VHAN dashboards present practice performance in terms of ED/inpatient visits compared to other VHAN pediatric practices. Additionally, dashboards provide patient information about what happened in the past, while Quality Measure reports provide an overview of actionable items. Access these new dashboards in your Box folder.
Each quarter, your practice receives a comprehensive Analytics Package in your Box folder. Analytics Packages include:
- Stratified Attribution Roster allows for purposeful, proactive outreach to patients based on multiple risk variables, such as flags for asthma or latest ED visit, as well as last appointment date.
- Clinician and Practice Dashboard Reports provide
individual tools for clinicians to understand performance
trends and identify rising risk patients. - Review your practice’s monthly Quality Measure reports
in Box to identify open care gaps for patients.
3. Share Patient and Parent Educational Materials
It’s important to provide patients and their families with the resources they need to control their asthma and avoid trips to the ED or hospital. Materials available on the VHAN Hub include a list of potential asthma triggers, tips on how to return to school with asthma, instructional videos and easy-to-follow instructions on how to properly use an inhaler. Certain patient education materials are available in both English and Spanish.
To share certain VHAN-specific materials, your practice will need to sign up for the VHAN Badge program. From there you can download and print various educational pieces from the VHAN Hub to share with your patients and their families.
To access these materials, visit the link below:
https://vhanhub.com/provider-resources/pediatric-asthma
4. Take Advantage of Ongoing Learning Opportunities
Annual Asthma Training
Asthma is a condition that constantly changes as the child grows. It’s critical to stay updated on best practices to ensure your patient has control of their asthma. Watch VHAN’s annual asthma training and additional webinars hosted throughout the year, on-demand, on the VHAN Hub.
Provider Resources
As a VHAN member you also have access to asthma-specific provider resources from more information on asthma control tests, to various actions plans (both verbal and non-verbal).
To access the recorded training and additional asthma specific provider resources, including information on asthma control tests and verbal/non-verbal action plans, visit the link below:
https://vhanhub.com/provider-resources/pediatric-asthma
Also available on VHAN Hub is a link to the latest NIH Asthma Management Guidelines.
Nest Steps
Complete this brief online self-assessment to benchmark your current performance. Your responses will be reviewed by your VHAN team and used to offer specific recommendations.
Identify an Asthma Champion in your practice. This person will have a thorough understanding of asthma requirements to improve quality outcomes and asthma scores that count toward the pediatric modifier. The Asthma Champion will understand the importance of the asthma control test and flag patient charts of those needing a test, reviewing information with the clinical manager and provider.
Review your practice’s dashboard and reports located in your Box folder. Follow up with any patients who have a higher score on the stratified patient list and be aware of any concerning trends.
Visit the VHAN Hub to review both provider- and patient-facing resources.The VHAN pediatric team is constantly working to update those tools and resources to provideyou with the latest information.
Questions? Beverly Puckett Population Health Associate beverly.j.puckett@vhan.com