Introduction

The Need for Asthma Quality Improvement

As protectors of the public's health, State governments play a vital role in preventing asthma and controlling its consequences. Most States have some public resources invested in asthma prevention, monitoring, and care programs, although the level of investment may vary from State to State. As health care purchasers, States are responsible for ensuring that the health care they pay for on behalf of State employees, Medicaid clients, and other recipients meet standards of quality.

There are a number of reasons why States may want to take a closer look at improving quality of care for asthma, including:

• The increased prevalence of asthma, especially among children and adolescents.
• The disparities between various racial and ethnic groups in diagnosis and quality of asthma care.
• Interventions and treatment that can successfully control the disease and prevent attacks.
• The high health care cost of uncontrolled asthma and the potential for return on investment for purchasers, including State Medicaid agencies, through asthma quality improvement.

Go to Module 1 of the Resource Guide for more information on these topics.

Aim and Scope of This Workbook

The aim of this Workbook is to help State leaders develop information to support health care quality improvement. Its written exercises should help State leaders begin to think about an effective partnership for an initiative, assembly of available data for their State, questions to raise about interpretation of the data, and quality improvement techniques. It also should help readers apply information and concepts from the Resource Guide to their own States.

Upon completion of the Workbook, State leaders will be able to:

• Understand the key factors that determine whether there is a need for an asthma care quality improvement in their State (i.e., "make the case").
• Identify partners to plan, develop, and support a quality improvement strategy for asthma.
• Identify national, public-private, Federal, State, and local resources and activities related to asthma quality improvement.
• Identify appropriate asthma data sources and measures and develop estimates from data for assessing the State's performance in providing asthma care.
• Identify opportunities to contribute to improving asthma care quality.

This Workbook is a start for State leaders interested in learning about quality improvement for asthma care. The actual planning, implementation, tracking, and evaluation of an asthma care quality improvement program will go well beyond this Workbook and its companion Resource Guide. Carrying out such a program will require a team of experts: State leaders and agency staff, program staff, topic experts, researchers, health specialists, statisticians, data collection experts, evaluation researchers, and representatives from stakeholder groups.

Who Should Use This Workbook

This workbook is intended for multiple users:

• State elected leaders—governors and legislators (and their staffs) who provide leadership on health policy.
• State executive branch officials—State health departments, asthma prevention and control program leaders, Medicaid officials, benefit managers for State employees, and their staffs.
• Nongovernmental State and local health care leaders—professional societies, provider associations, hospital associations, quality improvement organizations, voluntary health organizations, health plans, business coalitions, community organizations, and consumer groups.

How To Use This Workbook

Although this Workbook can be completed by one individual, it would be a time-consuming task. Furthermore, few State leaders may be equipped to answer all of the questions. Therefore, State leaders may want to enlist the help of staff and others who will eventually become part of the quality improvement team that will develop, implement, and evaluate an asthma care quality improvement program.

The user should first read the Summary and Introduction of the Resource Guide for an overview of the National Healthcare Quality Report. This report—produced annually by AHRQ, along with its companion National Healthcare Disparities Report—serves as the basis for measures and data used in the Resource Guide and this Workbook. Modules in the Resource Guide are mirrored in this Workbook; and, based on the State leader's interests, needs, and role in developing a quality improvement program, users will want to focus on different modules such as:

Senior leaders:

• Module 1—Making the Case for Asthma Care Quality Improvement
• Module 2—A Framework for State-Led Quality Improvement
• Module 3—Learning From Current State Quality Improvement Efforts
• Module 5—Moving Ahead: Implications for State Action

Staff specialists (all of above plus the following):

• Module 4—Measuring Quality of Care for Asthma

Modules 1, 2, and 3 might be completed by different individuals or groups of individuals to gather and assess information to create a quality improvement team and strategy specific to the State's needs. Module 4 provides guidance on available measures and how to use and interpret them in a quality improvement program. Module 5 will help State leaders assess their strengths and weaknesses in instituting improvement in health care quality.

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