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Release Notes:
Measure Information Form
Version 2010A1


Measure Information Form

Measure Set: Children’s Asthma Care (CAC)

Set Measure ID: CAC-1

Set Measure ID Performance Measure Name
CAC-1a * Relievers for Inpatient Asthma (age 2 through 17 years) – Overall Rate
CAC-1b * Relievers for Inpatient Asthma (age 2 through 4 years)
CAC-1c * Relievers for Inpatient Asthma (age 5 through 12 years)
CAC-1d * Relievers for Inpatient Asthma (age 13 through 17 years)
* Joint Commission Only

Performance Measure Name: Relievers for Inpatient Asthma

Description: Use of relievers in pediatric patients admitted for inpatient treatment of asthma

Rationale: 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 dollars 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 (AAP), recommend the use of relievers to gain control of acute asthma exacerbation and reduce severity as quickly as possible, with step down medication to the least medication necessary to maintain control. However, there is evidence that these guidelines are not followed uniformly. For example, Crain, et al. (1995) found that fewer than half of hospital emergency department survey respondents had heard of the NHLBI guidelines and that there was variation in the use of relievers. Administration of appropriate medication therapy is under the direct control of the care provider.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Pediatric asthma inpatients who received relievers during hospitalization.
Included Populations:
  • Patients who were administered relievers during this hospitalization.

Excluded Populations: None

Data Elements:

Denominator Statement: Pediatric asthma inpatients (age 2 years through 17 years) who were discharged with a principal diagnosis of asthma

Included Populations: Discharges with:
  • An ICD-9-CM Principal Diagnosis Code of asthma (as defined in Appendix A, Table 6.1)
  • An age of 2 through 17 years.

Excluded Populations:

  • Patients with age less than 2 years or 18 years or greater
  • Patients who have a Length of Stay >120 days
  • Patients enrolled in clinical trials
  • Patients for whom use of relievers is contraindicated

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Retrospective, data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: Based on these data, healthcare organizations would be able to determine the overall percentage of pediatric asthma inpatients that do not receive appropriate quick relief or rescue treatment. This measure provides opportunity to assess differences, if any, in treatment modality for the different age groups.

Sampling: Yes. For additional information see the Sampling Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

  • Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P, Livingston JM, Weiss KB, and Weiss ST (2001). Use of Inhaled Anti-inflammatory Medication in Children with Asthma in Managed Care Settings. Archives of Pediatrics and Adolescent Medicine, 155, 501-507.
  • Clinical Practice Guidelines of the American Academy of Pediatrics: A Compendium of Evidence-Based Research for Pediatric Practice. American Academy of Pediatrics, 1999.
  • Crain EF, Weiss KB and Fagan MJ (1995). Pediatric Asthma Care in U.S. Emergency Departments. Archives of Pediatric and Adolescent Medicine. 149, 893-901.
  • Gross KM, Ponte CD (1998). New Strategies in the Medical Management of Asthma. American Family Physician. 58:1 http://www.aafp.org/
  • McCormick MC, Kass B, Elixhauser A, Thompson J and Simpson L (2000). Annual Report on Access to and Utilization of Health Care for Children and Youth in the United States – 1999. Pediatrics, 105:1, 219-230.
  • Silber JH, Rosenbaum PR, Even-Shoshan O, Shabbout M, Zhang X, Bradlow ET, and Marsh RR (2003). Length of Stay, Conditional Length of Stay, and Prolonged Stay in Pediatric Asthma. Health Services Research, 38: 3, 867-886.
  • Guidelines for the Diagnosis and Management of Asthma (2002). http://www.nhlbi.nih.gov/guidelines/asthma/index.htm
  • Asthma Management Model System,
  • National Asthma Education and Prevention Program,

Measure Algorithm:

Attach file

Related Topics

Measure Information Form CAC-1
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)