This measure* is used to assess the percent of pediatric patients age 2 years through 17 years admitted for inpatient treatment of asthma who received systemic corticosteroids during hospitalization.

*This is a Joint Commission only measure.

Asthma is the most common chronic disease in children and a major cause of morbidity and increased health care expenditures nationally (Adams et al., 2001). For children, asthma is one of the most frequent reasons for admission to hospitals (McCormick et al., 1999). Silber et al. (2003) noted that there are approximately 200,000 admissions for childhood asthma in the United States annually, representing more than $3 billion in healthcare costs. Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. Guidelines for the diagnosis and management of asthma in children developed by the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung, and Blood Institute (NHLBI), as well as by the American Academy of Pediatrics, recommend the use of systemic corticosteroids to gain control of acute asthma exacerbation and reduce severity as quickly as possible in children with mild, moderate and severe persistent asthma. However, there is evidence that these guidelines are not followed uniformly. For example, Crain et al. (1995) found that fewer than half of respondents to a survey of hospital emergency departments had heard of the NHLBI guidelines and that there was considerable variation in use of systemic corticosteroids in relation to the guidelines. Administration of appropriate medication therapy is under the direct control of the care provider.

Pediatric asthma; use of systemic corticosteroids

Pediatric asthma inpatients (age 2 years through 17 years) who were discharged with a principal diagnosis of asthma (see the related "Denominator Inclusions/Exclusions" field)

Pediatric asthma inpatients who received systemic corticosteroids during hospitalization

Unspecified

Unspecified

Age 2 through 17 years

Discharges January 1 through June 30 and July 1 through December 31

Inclusions
Pediatric inpatient discharges, age 2 years through 17 years, with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Principal Diagnosis Code of asthma (as defined in the appendices of the original measure documentation)

Exclusions

• Patients with an age less than 2 years or 18 years or greater
• Patients who have a Length of Stay (LOS) greater than 120 days
• Patients enrolled in clinical trials
• Patients with a documented Reason for Not Administering Systemic Corticosteroids (as defined in the Data Dictionary)

Inclusions
Pediatric asthma inpatients who received systemic corticosteroids during hospitalization

Exclusions
None

Unspecified

This measure is disaggregated according to the following age ranges:

• Age 2 through 4 years
• Age 5 through 12 years
• Age 13 through 17 years

There are three distinct strata or sub-populations within the Children's Asthma Care (CAC-2) Topic Population, and results are stratified by age range. The patients in each stratum are counted in the International Classification of Diseases (ICD) Population of multiple measures.

• Age 2 through 4 years
• Age 5 through 12 years
• Age 13 through 17 years

Refer to the CAC ICD Population in the original measure documentation for further details.

CAC-2: systemic corticosteroids for inpatient asthma (age 2 years through 17 years).

All external funding for measure development has been received and used in full compliance with The Joint Commission's Corporate Sponsorship policies, which are available upon written request to The Joint Commission.

Unspecified

Expert panel members have made full disclosure of relevant financial and conflict of interest information in accordance with the Joint Commission's Conflict of Interest policies, copies of which are available upon written request to The Joint Commission.

2012 Jul 31

This measure was adapted from another source.

This measure is reviewed and updated by the developing organizations every 6 months.

Unspecified

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital quality measures, version 3.1a. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2010 Apr. various p.

The individual measure, "CAC-2: Systemic Corticosteroids for Inpatient Asthma (Age 2 Years through 17 Years)," is published in the "Specifications Manual for National Hospital Inpatient Quality Measures." This document is available from The Joint Commission Web site . Information is also available from the QualityNet Web site . Check The Joint Commission Web site and QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

The following are available:

• The Joint Commission. A comprehensive review of development and testing for national implementation of hospital core measures. Oakbrook Terrace (IL): The Joint Commission; 40 p. This document is available in Portable Document Format (PDF) from The Joint Commission Web site .
• The Joint Commission. Attributes of core performance measures and associated evaluation criteria. Oakbrook Terrace (IL): The Joint Commission; 5 p. This document is available in PDF from The Joint Commission Web site .
• Hospital compare: a quality tool provided by Medicare. [internet]. Washington (DC): U.S. Department of Health and Human Services; [accessed 2012 Jan 16]. This is available from the Medicare Web site.  See the related QualityTools  summary.

This NQMC summary was completed by ECRI Institute on January 9, 2008. The information was verified by the measure developer on February 4, 2008. The measure developer informed NQMC that this measure was updated on June 30, 2008 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on November 11, 2008. The measure developer informed NQMC that this measure was updated again on July 6, 2009 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on October 9, 2009. The Joint Commission informed NQMC that this measure was updated again on July 17, 2010 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on September 28, 2010. This NQMC summary was retrofitted into the new template on May 17, 2011. The Joint Commission informed NQMC that this measure was updated again on April 24, 2012 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on November 27, 2012.

The Specifications Manual for National Hospital Inpatient Quality Measures [Version 4.1, July, 2012] is the collaborative work of the Centers for Medicare & Medicaid Services and The Joint Commission. The Specifications Manual is periodically updated by the Centers for Medicare & Medicaid Services and The Joint Commission. Users of the Specifications Manual for National Hospital Inpatient Quality Measures should periodically verify that the most up-to-date version is being utilized.