November 14, 2024
WASHINGTON, DC – November 14, 2024 – The National Committee for Quality Assurance (NCQA) today announced the release of a new white paper titled,” Improving Outcomes for People with Asthma: Challenges & A Call to Action.” The report is a result of an NCQA roundtable discussion on how to improve access to appropriate asthma care, assure that clinical care aligns with a quality framework, and provide more patient-centered care. Held in May 2024, NCQA in collaboration with AstraZeneca Pharmaceuticals, LP, convened the Asthma Management & Education Roundtable, which included a diverse panel of clinicians, public/community health experts and patient advocates.
Asthma is a complex, chronic disease that affects nearly 24 million people in the U.S. Despite decades of advances in respiratory care that can help make the condition manageable, asthma outcomes remain poor. In 2021, 6.5% of children and 8% of adults in the U.S. had asthma, and the health consequences of uncontrolled asthma are expected to amount to 15.46 million quality adjusted life-years lost and $300.6 billion in direct costs between 2019 and 2038. There is a critical gap between best practices for asthma care and patients’ reality—and the gap widens depending on a patient’s race, socioeconomic status and place of residence.
“Compared to other chronic diseases, such as diabetes or heart failure, asthma care needs a lot of attention. As a society, we must do a better job at helping people manage their asthma while addressing their health-related social needs and environmental and social factors that impact their outcomes,” said NCQA Assistant Vice President of the Chronic Conditions and Complex Care Knowledge Center Caroline Blaum. “Engaging with various health care thought leaders about asthma and its management is key to a well-rounded discussion about barriers and solutions in asthma treatment. These focused discussions pointed to various issues related to asthma management and uncovered much needed improvements.”
Roundtable participants outlined six strategies to improve asthma outcomes in the United States including:
- Coverage: All people should have appropriate and standardized insurance coverage for their asthma care, self-management support and education, care coordination, and evidence-based pharmacological treatment. Interventions such as virtual care and home visits should be covered, as well as office spirometry.
- Workforce: While the clinician workforce for asthma care is in short supply, reinforcements are available if appropriate clinicians are enlisted including nurse practitioners, urgent care clinicians, and physician assistants. In some areas of the county, particularly in rural areas, primary care, pulmonary, and allergy specialists can be unavailable and telehealth and licensing across states may assist in brining needed specialty care to shortage areas. Additionally, community pharmacists can support evidence based pharmaceutical care, and community health workers can help establish meaningful contact and educational assistance. Regardless, all providers who interact with asthma patients need training and resources to understand guidelines and best practices.
- Quality Framework: Quality metrics and standards for asthma care are underdeveloped, outdated or not consistent with guidelines compared to those for other chronic diseases. Measure developers need to develop metrics based on current guidelines for medical care that can be used for quality improvement as well as accountability and provider incentives. Measurement should consider addressing important issues such as availability of patient self-management support, care coordination, patient reported outcomes, and pediatric asthma care.
- Care Delivery: Assure that asthma prescribing is based on current guidelines with inhaled corticosteroids (ICS) as the basis of therapy, with appropriate provision of other reliever and controller medications and biologics as appropriate. Principles of chronic disease management should be applied to asthma, including patient education and self-management support, care coordination, use of multidisciplinary teams for management, and home visits. EHR interoperability is important to allow different providers to communicate.
- Person-Centered Care: Clinicians should implement a culture of “asthma wellness,” so that patients and families understand that asthma symptoms and exacerbations are nearly entirely preventable. In addition, clinicians should be trained in principles of patient-centered care and techniques related to patient engagement, such as motivational interviewing and shared decision making. Human centered design methods should be employed to meet patients where they are and provide innovative and age-appropriate self-management such as social media and games.
- Environmental and Other Policy: Knowing that air quality is critical, and poor air quality is often associated with underserved areas, policy interventions are needed, such as defining lower acceptable particulate matter thresholds. Other policy interventions could encourage/reimburse home visits for asthma trigger investigation, and public private partnerships, such as using pollutant taxes to fund remediation work, should be considered.
The roundtable discussion concluded with the alignment that there is much work to do to make high quality care available to all asthma patients. A range of barriers and challenges need to be addressed, and all stakeholders must work together to achieve the goals. It will take innovative approaches, forward thinking momentum, and the cooperation and coordination of payers, employers, states, the federal government, and providers to work together to bridge the gap between the clinical ideal for asthma care and the disparate lived experiences and outcomes that patients often face.
About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations. It also Recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make informed health care choices. NCQA can also be found at Twitter/X @ncqa and on LinkedIn at linkedin.com/company/ncqa.
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