HEDIS^® Tip Sheet

Notes

Members are included in the eligible population if they have had at least one of the following criteria during both the measurement year and the year prior:

• ED visit with a principal diagnosis of asthma.
• Acute inpatient encounter with a principal diagnosis of asthma.
• Four outpatient visits, telephone visits or e-visits or virtual check-ins, on different dates of service, with any diagnosis of asthma and at least two asthma medication dispensing events for any controller or reliever medication.
• Four asthma medication dispensing events for any controller or reliever medication.
• A member identified as having persistent asthma because of at least four asthma medication dispensing events, where leukotriene modifiers or antibody inhibitors were the sole asthma medication dispensed in that year, must also have at least one diagnosis of asthma, in any setting.
• Measure compliance (numerator):
  Members who have a medication ratio of 0.50 or greater.
  Ratio:

Best Practices

• Emphasize the importance of daily use of controller medications and provide clear instructions on how to use them correctly, including proper inhaler technique.
• Once stable, prescribe a 90-day supply and encourage the use of mail-order pharmacy.
• Ensure accurate diagnosis coding, avoiding coding asthma when the condition is an asthma-like symptom (e.g., wheezing during a viral infection).
• Assist patients in identifying and eliminating asthma triggers in their home environment, such as dust mites, pets, and mold.
• Offer resources and support for smoking cessation, as tobacco smoke is a major asthma trigger.
• Educate patients on the importance of adherence to prescribed medication regimen.
• Include patient concerns/input in decision making processes for a treatment plan they can adhere to (i.e., once daily dosing, generic options, and medications to minimize side effects).
• Schedule and encourage routine follow-up and monitoring.

Exclusions

• Members who had a diagnosis that requires a different treatment approach than members with asthma (i.e., cystic fibrosis, emphysema, COPD, acute respiratory failure, chronic respiratory conditions caused by fumes or vapors, etc.).
• Members who had no asthma controller or reliever medications dispensed during the measurement year.
• Members who use hospice services.
• Members who die any time during the measurement year.