Project Overview

This project is sponsored by the New York State Department of Health's Office of Health Insurance Programs. The 2002 National Asthma Education and Prevention Program (NAEPP) guidelines are used to assess the quality of asthma care at 24 clinics and community health centers in New York State. The major goals of this project are to: develop a quality indicator monitoring system; improve processes of care; and improve patient perceptions of care received and knowledge and capacity for self-management.

Asthma is one of the most common chronic diseases in the United States and has become a serious health threat over the last 20 years. It is a chronic inflammatory lung disease that is characterized by variable airflow obstruction and airway hyper-responsiveness. Asthma is a complex disease that affects people physically, socially, and emotionally. Despite improvements in the understanding of the mechanisms of asthma and availability of effective medications, the incidence and mortality rates of asthma continue to increase.

From 1980 to 1996, the number of Americans afflicted with asthma more than doubled to almost 15 million. Children under 5 years old experience the highest rate of increase. In 1994, 5.8% of children under age 5 had asthma (as reported by a family member). This is a 160% increase since 1980 (Surveillance for Asthma: United States 1960-1995, 1998). According to the center for Disease Control, in 1998 asthma affected 17,299,000 people in the United State. In New York State, there were 1,236,200 persons with asthma, for an estimated prevalence of 6.8%. New York ranked second, only to California, with having the most people with asthma in the United States.

Statistics from the American Lung Association (2000) report that between 1979 and 1998, the adjusted mortality rate increase was 56%. In 1998, the age-adjusted death rate for African Americans was more than 3 times the rate in the white population. On 10/05/01, the National Center for Health Statistics (2001) released asthma mortality rates that showed the number of asthma deaths increased progressively from 1,800 in 1978 to 5,438 in 1998.

O'Hollaren (2001) reports that the cost of asthma care is approximately 1% to 1.5% of the US health care budget. In 2000, expenditures for asthma were estimated to be 14.5 billion dollars (National Center for Environmental Health, 2000). The annual cost of medical care for children with asthma is 1,050 dollars compared to children without asthma, where the cost of medical care is 600 dollars. About 10 million school days are lost due to asthma (United States Environmental Protection Agency, 2000). It also, is associated with lost productivity, such as when a parent stays home from work to care for an asthmatic child. People who continue to experience poorly controlled asthma, lose significant time from work or school, and incur considerable costs for physician visits, emergency care, and hospitalizations (Barbee, Dodge, & Leibowitz, 1985).

Asthma accounts for approximately 10 million physician office visits, 400,000 hospitalizations, and 1 million emergency room visits annually (American College of Allergy, Asthma, and Immunology, 2000). Asthma related hospitalizations have risen disproportionately for inner city children and in particular, the minority population. In 1993, New York City children were hospitalized at more than four times the national rate. In 1995, 14,504 New York City children were hospitalized with asthma. Children, under the age of 5, accounted for the largest proportion of the problem (New York City Childhood Asthma Initiative, 1998).

Failure to meet treatment standards for asthma management may negatively affect the health and functional status of patients with asthma and is likely to result in increased use of the Emergency Room and result in hospitalization (Herman, O'Connor, & Hasan, 1998).

There are many reasons for failures of asthma treatment, but three appear to be especially important, as noted at the 57th Annual Meeting of the American Academy of Allergy, Asthma, and Immunology by Lazarus (2001). They are:

Failure to providers to follow asthma treatment guidelines
Insufficient patient education
Failure of patient's to adhere to prescribed treatment regiment

In 1997, the National Asthma Education and Prevention Program (NAEPP) published the most recent guidelines NAEPP's recommendations focus on four areas of asthma care: diagnosis of asthma and establishing a partnership with patient, reduction of inflammation, symptoms, and exacerbation, monitoring asthma over time, and prompt treatment of asthma episodes. In 2002, an update to the NAEPP published an update to the guidelines. The 2007 NAEPP guidelines are in final review and will be released publicly soon.

Overview and Goals

In October 2000, IPRO sponsored by the then New York State Department of Health (NYSDOH) Office of Medicaid Management embarked on a project whose goals are:

To improve processes of asthma care at selected Article 28 practices and community health centers in part through retrospective chart review and feedback to the practices' clinicians
To improve patient perceptions of care received and knowledge/capacity for self-management
To promote and disseminate quality improvement materials/interventions at these sites and to medical practices through out New York State
To develop a quality indicator monitoring system for selected Article 28 practices and community health centers