This application proposes to develop key technical quality-of-care measures for adult asthma. The work plan is divided into two phases. Phase 1 includes the development of the technical quality-of-care measures and, phase 2 will test and evaluate the measures. In phase 1, the investigators will also determine what factors (environmental, patient, and structural variables) affect outcome. The outcomes to be evaluated are: 1) objective measurement of lung function, 2) asthma quality of life, 3) satisfaction with medical care, 4) medical facility utilization for asthma exacerbation, and 5) asthma mortality. Phase 1: During the first 12 months an expert committee will select the key technical quality-of-care measures that will be evaluated (e.g., received a prescription for steroids). Forms will be developed to collect information on: 1) patient environmental, aeroallergen, and sociodemographic data, 2) process-of-care data, 3) clinical structural data, 4) provider data on the process of care from both the medical record and care provider interview, and 6) patient asthma outcomes. Using the Parkland Memorial hospital (Parkland) administrative database to identify patients with asthma using ICD-9 codes, the medical record will be reviewed to confirm the episode of asthma exacerbation, and the patient will be contacted to participate in the project. Enrolled patients will be seen in the allergy clinic, where skin testing for common allergens and pre- and post-bronchodilator FEV1 measurement will be done, along with completion of the selected instruments (McMaster University Asthma Quality of Life Questionnaire, Patient Satisfaction Questionnaire). Logistic modeling will be used to predict outcome from the process and non-process-of-care predictors (asthma severity score, asthma knowledge, etc.). A short pilot study will determine the validity and reliability of the data-collection methodologies to identify the selected measures. The logistic-modeling analysis will be reviewed by the expert committee to select the key technical quality-of-care measure candidates for Phase 2. Phase 2 will involve a second effectiveness-of-care project that will occur concurrently with two audits. Phase 2 will be similar to phase 1, except that only the selected key measures will be collected, along with the non-process-of-care variables that were shown to be predictive of outcome. At the same time, two audits will be conducted. The first involves determining the sensitivity (how frequently the measure detects deficient or inappropriate care) and specificity (how frequently the measure misses inadequate care) of candidate measures. The second audit will collect information on the feasibility and cost of the measurement process.
