Children’s Asthma Care (CAC)

Set Measures

Set Measure ID	Measure Short Name
CAC-1	Relievers for Inpatient Asthma
CAC-2	Systemic Corticosteroids for Inpatient Asthma
CAC-3	Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver

General Data Elements

Element Name	Collected For
Birthdate	All Records,
Discharge Date	All Records, (used in algorithm for AMI-1, AMI-6, PN-1, PN-3a, PN-3b, PN-5, PN-5b, PN-5c, PN-6, PN-6a, PN-6b, PN-7, PR-2, SCIP-Inf-4, SCIP-VTE-1, SCIP-VTE-2)
Discharge Status	All Records, (used in algorithm for AMI-1, AMI-2, AMI-3, AMI-4, AMI-5, AMI-6, AMI-9, AMI-T1a and AMI-T2 [CMS Optional Test Measures], CAC-3 [Joint Commission Test Measure], All HF Measures, All PN Measures, PR-2)
First Name	All Records, CMS Only,
Hispanic Ethnicity	All Records, CMS Only,
Hospital Patient Identifier	All Records, CMS Only, NOTE: Refer to the Hospital Clinical Data XML File Layout in the Transmission section of this manual.
Last Name	All Records, CMS Only,
Patient HIC#	All Records, CMS Only, Collected by CMS for patients with a Payment Source - Medicare who have a standard HIC number.
Physician 1	All Records, Optional for All Records, (CMS Optional Element)
Physician 2	All Records, Optional for All Records, (CMS Optional Element)
Point of Origin for Admission or Visit	All Records, (used in algorithm for AMI-1, AMI-6, AMI-7, AMI-7a, AMI-8, AMI-8a, AMI-9, PN-1, PN-3a, PN-5, PN-5b, PN-5c, PN-6, PN-6a, PN-6b
Postal Code	All Records, CMS Only,
Race	All Records, CMS Only,

Algorithm Output Data Elements

Element Name	Collected For
Measure Category Assignment	Joint Commission Only, Calculation, Transmission, Hospital Clinical Data File

Measure Set Specific Data Elements

Element Name	Collected For
Contraindication to Systemic Corticosteroids	CAC-2,
Contraindication to Relievers	CAC-1,
Home Management Plan of Care Document Addresses Arrangements for Follow-up Care	CAC-3,
Home Management Plan of Care Document Addresses Environmental Control and Control of Other Triggers	CAC-3,
Home Management Plan of Care Document Addresses Methods and Timing of Rescue Actions	CAC-3,
Home Management Plan of Care Document Addresses Use of Controllers	CAC-3,
Home Management Plan of Care Document Addresses Use of Relievers	CAC-3,
Home Management Plan of Care Document Given to Patient/Caregiver	CAC-3,
Home Management Plan of Care Document Present	CAC-3,
Relievers Administered	CAC-1,
Systemic Corticosteroids Administered	CAC-2,

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Related Materials

	Document Name
	a. Table of Contents
	a1. Introduction to the manual
	a2. Acknowledgement and Conditions of Use
	a3. Using the Specifications Manual for National Hospital Inpatient Quality Measures
	b. Introduction to the Data Dictionary and lists of all data elements
	d. Missing and Invalid Data Chapter
	e. Population and Sampling Specifications
	j. National Hospital Quality Measure Data Transmission
	j1. Transmission Alphabetical Data Dictionary
	j2. Joint Commission and CMS Data Processing Flow
	z. Appendix A - ICD-9-CM Code Tables
	z. Appendix C - Medication Tables
	z. Appendix D - Glossary of Terms
	z. Appendix E - Measure Information Form and Flowchart Definitions
	z. Appendix G - Resources
	z. Appendix H - Miscellaneous Tables

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Note:
The initial Children’s Asthma Care (CAC) measure set is comprised of 3 performance measures. CAC-1 and CAC-2 are NQF endorsed and on the HQA implementation agenda, however CAC-3 is currently pending NQF review and endorsement. Therefore, CAC-3 will be implemented as a test measure pending NQF endorsement. As a test measure, it will not be publicly reported pending NQF endorsement.

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Children’s Asthma Care (CAC) Initial Patient Population

The population of the children’s asthma care (CAC) measure set can be identified by using four data elements that are common to all of the performance measures in the set:

• ICD-9-CM Principal Diagnosis Code
• Admission Date
• Birthdate
• Discharge Date

The CAC Topic Population (common to all CAC measures) is defined as patients admitted to the hospital for inpatient acute care with an ICD-9-CM Principal Diagnosis Code for asthma as defined in Appendix A, Table 6.1, a Patient Age (Admission Date – Birthdate) >= 2 years and < 18 years (age 2 through 17 years), and a Length of Stay (Discharge Date - Admission Date) <= 120 days. There are three distinct strata or sub-populations within the CAC Topic Population, each identified by a specific age range. The patients in each stratum are counted in the Initial Patient Population of multiple measures.

Measures	Age Strata	Initial Patient Population definition
CAC-1a and 2a (overall measures)	Age 2 years through 17 years	The count of all patients in strata 1, 2, and 3
CAC-1b and 2b	Age 2 years through 4 years	The count of all patients in stratum 1
CAC-1c and 2c	Age 5 years through 12 years	The count of all patients in stratum 2
CAC-1d and 2d	Age 13 years through 17 years	The count of all patients in stratum 3
CAC-3	Age 2 years through 17 years	The count of all patients in strata 1, 2, and 3

Patients admitted to the hospital for inpatient acute care with an ICD-9-CM Principal Diagnosis Code for asthma as defined in Appendix A, Table 6.1 are included in one of the CAC ICD Strata Populations and are eligible to be sampled if they have:

Stratum 1 – Age 2 years through 4 years stratum – A Patient Age (Admission Date – Birthdate) >= 2 years and < 5 years, and a Length of Stay (Discharge Date - Admission Date) <= 120 days.

Stratum 2 - Age 5 years through 12 years stratum – A Patient Age (Admission Date – Birthdate) >= 5 years and < 13 years, and a Length of Stay (Discharge Date - Admission Date) <= 120 days.

Stratum 3 - Age 13 years through 17 years stratum – A Patient Age (Admission Date – Birthdate) >= 13 years and < 18 years, and a Length of Stay (Discharge Date - Admission Date) <= 120 days.

• View the CAC Initial Population Algorithm

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Sample Size Requirements

Hospitals that choose to sample have the option of sampling quarterly or sampling monthly. A hospital may choose to use a larger sample size than is required. Hospitals whose Initial Patient Population size is less than the minimum number of cases per quarter/month for the stratum cannot sample that stratum.

Regardless of the option used, hospital samples must be monitored to ensure that sampling procedures consistently produce statistically valid and useful data. Because the sample for a measure set will rarely be equal to the effective sample due to exclusions and contraindications, hospitals selecting sample cases MUST submit AT LEAST the minimum required sample size.

The following sample size tables for each option automatically build in the number of cases needed to obtain the required sample sizes. For information concerning how to perform sampling, refer to the Population and Sampling Specifications section in this manual.

Quarterly Sampling

For hospitals selecting sample cases for CAC, a modified sampling procedure is required. Hospitals selecting sample cases for this set must ensure that each individual stratum’s population and effective quarterly sample size meets the following conditions:

• Select within each of the three individual measure strata. The effective quarterly sample size within a stratum is at least 39 cases. Cases are placed into the appropriate stratum based upon the patient’s age.
• The required quarterly sample size is at least 20% of the stratum population for the quarter.

Quarterly Sample Size
Based on Initial Patient Population for the CAC Measure Set

Hospital's Measures
Average Quarterly Stratum Initial Patient Population Size “N”	Minimum Required Stratum Sample Size “n”
> 970	195
196 - 970	20% of the Initial Patient Population
39 – 195	39
< 39	No sampling; 100% of the Initial Patient Population is required

Monthly Sampling

For hospitals selecting sample cases for CAC, a modified sampling procedure is required. Hospitals selecting sample cases for this set must ensure that each individual strata population and effective monthly sample size meets the following conditions:

• Select within each of the three individual measure strata. The effective monthly sample size within a stratum is at least 13 cases. Cases are placed into the appropriate stratum based upon the patient’s age.
• The required monthly sample size is at least 20% of the stratum population for the month.

Monthly Sample Size
Based on Initial Patient Population for the CAC Measure Set

Hospital's Measures
Average Monthly Stratum Initial Patient Population Size “N”	Minimum Required Stratum Sample Size “n”
> 320	65
66- 320	20% of the Initial Patient Population
13 – 65	13
< 13	No sampling; 100% of the Initial Patient Population is required

Sample Size Examples

Note: All sampled strata in CAC should be used in the calculation of all CAC measures. All of the CAC measures' specific exclusion criteria are used to filter out cases that do not belong in the measure denominator. Using CAC-2b as an example, include cases covering all sampled strata, although the measure-specific exclusion criteria would only allow cases with an age of 2 years through 4 years to be included in the denominator.

• Quarterly sampling:
  When applicable, larger hospitals must also abide by the required quarterly sample sizes for the three individual measure strata a minimum of 39 required sample cases per stratum when Initial Patient Population size is 39 or greater.
  
  • The CAC Initial Patient Population sizes for a hospital are 5, 301, and 1000 patients respectively per quarter. The required quarterly sample sizes would be 5, 61, and 195.
    • The 1st stratum is less than the minimum required quarterly sample size, so 100% of this stratum is sampled.
    • The 2nd stratum has 301 patients per quarter, which requires a 20% sample size, of 61 cases (twenty percent of 301 equals 60.2 rounded to the next highest whole number = 61).
    • The 3rd stratum has 1000 patients per quarter, which is more than the maximum condition, so a minimum of 195 cases are required to be sampled.

• Monthly sampling:
  When applicable, larger hospitals must also abide by the required monthly sample sizes for the three individual measure strata a minimum of 13 required sample cases per stratum when Initial Patient Population size is 13 or greater.
  
  • The CAC Initial Patient Population sizes for a hospital are 5, 301, and 350 patients respectively in July. The required monthly sample sizes would be 5, 61, and 195.
    • The 1st stratum is less than the minimum required monthly sample size, so 100% of this stratum is sampled.
    • The 2nd stratum has 301 patients per month, which requires a 20% sample size, of 61 cases (twenty percent of 301 equals 60.2 rounded to the next highest whole number = 61).
    • The 3rd stratum has 350 patients per month, which is more than the maximum condition, so a minimum of 65 cases are required to be sampled.