1. 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

2. Assumption:
Quality
Result

3. Objectives: Identify quality related outcomes
Suggest quality indicators
Develop process to assess indicators
Use indicators to modify practice

4. 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

5. ASTHMA APGAR A=Activities P=Persistence G=triGGers
A=Asthma Medications
R=Response to Therapy

6. % of patients with documented activity limits
APGAR Results
A=Activities
25%
% of patients with documented activity limits

7. % of patients with frequency of daytime symptoms documented
APGAR Results
P=Persistence
Day time symptoms
67%
% of patients with frequency of daytime symptoms documented

8. % of patients with frequency of night time symptoms documented
APGAR Results
P=Persistence
Night time symptoms
15%
% of patients with frequency of night time symptoms documented

9. The severity score addresses the baseline symptom assessment:
Does not address the asthma that is being treated nor does it consider attacks

10. % of patients with documented triggers
APGAR Results
G=triGGers
Are them mentioned or treated
34%
% of patients with documented triggers

11. 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

12. % of patients with the response to therapy documented
APGAR Results
R=Response to therapy
Did they get better or worse
50%
% of patients with the response to therapy documented

13. 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?

14. 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