Table 1.

A sample of measures from the Asthma Care Quality (ACQ) measure set. (NOTE: Finalized measure set is available from authors upon request.)

Quality Measure	Denominator criteria [Index Date]	Numerator criteria [Measure Interval]	Operationalization Comments
Patients with the diagnosis of persistent asthma should have a historical evaluation of asthma precipitants	Patients with persistent asthma [Qualification Date]	Patients with a subjective evaluation of precipitants listed in provider’s notes [any documentation]	Probably only found in the text progress notes
Patients with the diagnosis of persistent asthma should have spirometry performed annually	Patients with persistent asthma [Qualification Date]	Patients with orders for PFTs or documentation of office spirometry [subsequent 12 months]	Numerator satisfied with documentation of referral to allergy or pulmonary specialist if no PFT known available with closed charting loop
Patients with the diagnosis of persistent asthma should have available short acting beta2-agonist inhaler for symptomatic relief of exacerbations	Patients with persistent asthma [Qualification Date]	Prescription for a short acting beta-2 agonist to use PRN [subsequent 12 months]	Numerator satisfied if prior / existing active Rx; also Ach or combination Rx (i.e. Combivent) or oral/nebulized PRN Rx will count. Exclusion if documented adverse reaction to β-agonists as allergy
Patients with persistent asthma should not receive non-cardioselective beta-blocker medications	Patients with persistent asthma [Qualification Date]	Pharmacy records without non- cardioselective beta-blocker prescription [subsequent 12 months]	e.g., nadolol, propranolol, pindolol
Patients with persistent asthma should have a flu vaccination annually	Patients with persistent asthma [Qualification Date]	Documentation of flu vaccination [prior 6 months or subsequent 12 months]	Numerator satisfied if vaccine documented regardless of where administered. Exclusion if documented egg allergy or patient refusal
All patients seen for an acute asthma exacerbation should have current medications reviewed	Patients with persistent asthma meeting criteria for outpatient exacerbation [exacerbation encounter]	Documentation that medications reviewed by provider [same visit]	Numerator satisfied if provider documents asthma specific medication history in notes or active management of current med list