Automating Assessment of Asthma Care Quality

Each year, thousands of preventable deaths are attributed to asthma, with resultant large economic burden. It has been estimated that half of asthma-related medical costs are attributed to hospitalizations, even though asthma is able to be managed through ambulatory and self-care. Opportunities to improve asthma care are dependent on the ability to assess the care that is delivered to these patients. However quality measurement is dependent on extensive clinical chart review that is unscalable unless electronically automated.

This project developed, implemented, and evaluated the viability of an automated method using natural language processing to conduct routine, comprehensive assessment of the quality of outpatient asthma care across different care systems. The research involved retrospective analysis of electronic medical record (EMR) data from two health systems: a mid-sized health maintenance organization (HMO) and a consortium of public health clinics and care organizations located primarily in the Pacific Northwest.

The specific aims of this project were as follows:

• Refine asthma care quality measures from the RAND Quality Assessment Tools Project for use as a quality measure set to evaluate ambulatory asthma care performance. 
• Develop and validate a generalizable and scalable automated method for applying the measures identified in aim 1, using comprehensive EMR data. 
• Apply the method developed in aim 2 to assess ambulatory asthma care quality in two distinct health plans representing diverse patient populations and care practices. 
• Evaluate the association between automated measures of adherence to recommended asthma care processes and measures of clinical outcomes. 

This project successfully developed a comprehensive set of 22 measures for assessing the quality of outpatient asthma care and operationalized 18 of them. The measures performed well, although unwanted measurement variation across health systems remained in some cases. The project team found that guideline-recommended care is associated with a reduction in the frequency and severity of asthma exacerbations.