patient safety and quality improvement act pdf asthma

Patient safety and quality improvement act pdf asthma

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Tools and Strategies for Improving Asthma Management

Professionals & Patients

Clinical Guidelines, Standards & Quality of Care

Symptom-free days per month are greater in the self-management studies.

Please visit the PSI web site. The statute was designed to improve patient safety in all NJ healthcare facilities by creating a confidential reporting system that allows healthcare facilities to report adverse events and associated root cause analyses RCAs to the DOH. The following facilities are currently required to report serious preventable adverse events to DOH:.

Tools and Strategies for Improving Asthma Management

Metrics details. However, the relationships between ACT score and other measures of asthma impact are not fully understood. Here, we evaluate how ACT scores relate to other clinical, patient-reported, or economic asthma outcomes. A targeted literature search of online databases and conference abstracts was performed. A total of publications were identified, 74 of which were included in the final analysis. Of these, 69 studies found that improvement in ACT score was related to improvement in outcome s , either as correlation or by association.

The level of evidence for each relationship differed widely between outcomes: substantial evidence was identified for relationships between ACT score and ACQ score, lung function, and asthma-related QoL; moderate evidence was obtained for relationships between ACT score and rescue medication use, exacerbations, sleep quality, and work and productivity; limited evidence was identified for relationships between ACT score and general health-related QoL, HRU, and healthcare costs.

Findings of this review suggest that the ACT is an appropriate measure for overall asthma impact and support its use in clinical trial settings. Peer Review reports. Asthma is a common and treatable disease that can impact heavily on health-related quality of life HRQoL [ 1 ]. Medical experts agree that the level of asthma control is a key feature when determining the best asthma treatment required [ 1 , 2 ].

Developed by asthma experts, the Asthma Control Test ACT provides a numerical score to assess the control of asthma [ 3 ]. It comprises five questions regarding aspects of asthma control relevant to patients. Each question is answered on a 5-point scale, with a total score ranging from 5 to 25; higher scores indicate improved asthma control [ 2 , 3 ].

The ACT provides patients with asthma and their doctors and nurses with a useful measure to help determine the level of treatment required [ 2 , 3 ]. It has been tested extensively in patients with asthma [ 4 ], clinically validated against spirometry and specialist assessment [ 3 ], and is recognized by the National Institutes of Health since its asthma guidelines [ 2 ]. Despite its clinical utility, a need remains to assess the link between ACT score and asthma treatment benefits and outcomes, and its suitability as an endpoint in clinical trials.

Previous studies have used the ACT as a measure of response to treatment [ 5 , 6 ], including a recent Phase III study that was not published in time to be included in this review [ 7 ]. The aim of the current study was to assess the extent to which ACT score is correlated, or associated, with other important clinical, patient-reported, and economic asthma outcomes.

The details of the search strategy are included in Fig. Flow diagram of search strategy and targeted literature review approach. Identified publications were initially screened for eligibility by title and abstract, and full-text articles of all eligible studies were then assessed.

Articles that met predefined inclusion criteria were retained for full text review i. Following identification of articles eligible for full-text review, the number of articles assessing each relationship, as well as the strength, significance, and direction of those relationships, was quantified.

Data for each outcome of interest were extracted from the targeted studies by means of a formalized extraction grid. Bibliographic and methodologic details of the study, basic population characteristics, and ACT scores at baseline and later if applicable were extracted. Relevant data were extracted from these publications, but no new data were generated within the course of this literature review.

Accordingly, no databases or data repositories were created. The protocol for this literature review is not publicly available. Of the unduplicated publications screened, were reviewed in full and 74 were included in the final analysis Fig.

The analysis found that in 68 publications an improvement in ACT score was correlated or associated with improvements in key outcomes of interest Table 1.

Studies assessing symptom control, healthcare resource use, or lung function were among the most commonly identified; fewer studies assessing QoL, sleep, and productivity were found. Asthma severity was not frequently reported. Six publications found strong and consistent correlations between improvement in ACT score and improvement in ACQ score [ 8 , 9 , 10 , 11 , 12 , 13 ], with five of the publications assessing the statistical significance of the correlations.

Schuler et al. Zhou et al. Almost all of the 10 publications reporting on ACT score and rescue medication use [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] found a relationship between worsening ACT scores and increasing short-acting beta agonist SABA or rescue inhaler use Table 1.

Only one study was identified that evaluated the relationship between ACT score and rescue medication-free days. Improvement was evaluated by both a change from baseline and the proportion of patients who achieved asthma control, similar to the Salford Lung Study trial design [ 25 ]. The results suggested that improvement in ACT score was related to improvement in rescue medication-free days [ 19 ]. Ten studies reported on the relationship between improvement in ACT score and reduction in asthma exacerbations Table 1 [ 17 , 22 , 23 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].

Across the studies, there was some variation in the definitions used to characterize an exacerbation. In the other eight publications, fewer exacerbations were observed in patients with higher ACT scores [ 17 , 22 , 23 , 28 , 29 , 30 , 31 , 32 ], with seven of these publications reporting a statistically significant relationship between higher ACT score and lower numbers of exacerbations in patients split into the various ACT subgroups [ 22 , 23 , 28 , 29 , 30 , 31 , 32 ].

Twenty-five articles were identified which assessed the relationship between ACT score and lung function. Of these, eight publications did not fully meet the predefined inclusion criteria and were therefore subsequently excluded from data extraction.

In total, 17 publications detailing studies that met the inclusion criteria reported lung function measurements [ 3 , 11 , 13 , 15 , 18 , 27 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], with some reporting multiple outcomes e.

Of the 14 publications reporting FEV 1 , seven reported statistically tested correlations between improvement in ACT score and improvement in FEV 1 [ 3 , 15 , 27 , 34 , 35 , 36 , 37 ]. Of these, five demonstrated statistically significant correlations, with coefficients ranging from 0.

This evidence was supported by the remaining seven studies, which tested the relationships between ACT score and FEV 1 by linear regression, analysis of variance ANOVA , or in subgroups of patients categorized according to ACT score or FEV 1 [ 11 , 13 , 18 , 38 , 39 , 40 , 43 ]; of these seven articles, six reported statistically significant relationships [ 11 , 13 , 38 , 39 , 40 , 43 ].

All seven studies published statistically significant results, five from correlation tests [ 28 , 34 , 44 , 45 , 46 ], and two derived from regression analyses [ 47 , 48 ].

In both questionnaires, a higher score indicates improved QoL. Guilbert et al. This finding is of particular interest, given that the EQ-5D system may lack sensitivity which often does not correlate with underlying clinical measures [ 56 , 57 ]. In total, six articles reported on aspects of sleep quality, including instruments that measured daytime sleepiness and obstructive sleep apnea [ 45 , 58 , 59 , 60 , 61 , 62 ]; three of these studies utilized multiple sleep quality instruments Table 1 [ 58 , 60 , 62 ].

Additionally, Lv et al. A relationship between the level of asthma control, as measured by ACT score, and improvement in sleep quality, as measured by the Sleep-5 questionnaire, was also reported, but the relationship was not tested for statistical significance [ 59 ]. Two studies reported that patients with lower ACT scores tended to have higher worse Epworth Sleepiness Scale scores, although no statistical analysis was performed [ 58 , 62 ].

Regression analyses unadjusted and adjusted were performed in one study to determine the relationship between asthma control measured by the ACT and the Berlin Questionnaire for obstructive sleep apnea [ 60 ]. Out of a total of seven articles, five reported on the relationship between improvement in ACT score and improvement in productivity, as measured by the Work Productivity and Activity Impairment questionnaire WPAI Table 1 [ 49 , 51 , 53 , 55 , 63 ].

However, only one of these found that relationship to be statistically significant [ 49 ]. Two studies reported on the relationship between the level of asthma control, as measured by ACT score, and improvement in productivity using other measures i.

Of these, one study reported a statistically significant relationship between the subgroup with improved asthma control and productivity measured by the Sheehan Disability Scale and IMPALA [ 57 ]. In total, 17 publications reported on the relationship between ACT score and HRU Table 1 [ 47 , 49 , 51 , 53 , 54 , 55 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ].

One study reported a non-significant relationship between improvement in ACT score and both the ratio of maintenance to reliever medication dispensed, and inhaler nebulization rates [ 66 ]. In total, six studies reported on costs [ 50 , 65 , 70 , 76 , 77 , 78 ], of which five reported relationships between asthma control subgroup and direct medical costs [ 50 , 65 , 70 , 76 , 77 ], and three with indirect medical costs [ 65 , 77 , 78 ].

However, only one study reported statistically significant results for direct medical costs [ 77 ]. This review aimed to qualitatively assess the link between ACT score and key asthma outcomes through a targeted review of the available literature. Substantial evidence was identified for relationships between ACT score and ACQ score, lung function, and asthma-related QoL; moderate evidence was obtained for relationships between ACT score and rescue medication use, exacerbations, sleep quality, and work and productivity; limited evidence was identified for relationships between ACT score and general health-related QoL, HRU, and healthcare costs.

While links to reductions in the use of rescue medication and the number of asthma exacerbations were also reported, there was limited or no evidence to suggest that there is a relationship between ACT score and general HRQoL, HRU, and healthcare costs. Overall, these findings support the use of the ACT in a clinical setting, as a valid measure of disease control and associated patient outcomes, including ongoing symptomology and future risk.

They also support the clinical use of the ACT to guide the appropriate management of patients with asthma, including when and how to select between alternative treatments. Additionally, the available evidence provides a foundation for the use of the ACT as a primary or secondary endpoint in clinical trials, allowing investigators to gauge accurately the effectiveness of a treatment.

The overall strength of this review is that it collates the published relationships between ACT score and a broad range of clinical outcomes into a coherent whole. Limitations include the targeted nature of the literature search, which may not have encompassed the full body of literature on the correlation being investigated, and the presence of large differences in scientific rigor and reporting standards between the included articles.

Additionally, the statistical power may have been inadequate in some of the evaluated studies, either by being insufficiently powered to evaluate the relationships between ACT score and the outcomes of interest, or overpowered to the extent such as a weak relationship became highly statistically significant. With respect to future work, the exploratory setup of this research provides a characterization of the topics on which scientific data regarding the ACT are present or absent.

As such, the current report provides a starting point to explore and corroborate these findings in future research initiatives on the value of ACT scores in real-world clinical settings.

More studies evaluating relationships between ACT score and general HRQoL, healthcare costs, and resource use are also needed, as well as additional research into relationships in populations with differing levels of asthma severity. Despite some limitations inherent to the nature of a targeted literature review, this report provides an informative qualitative assessment of the available literature on the relationships between ACT score and a broad range of outcomes of interest, supporting the use of the ACT in clinical practice and trial settings.

All data used in this review were taken from publicly available articles, and can be found at the relevant journal websites. Global Initiative for Asthma. Accessed 26 June National Heart, Lung, and Blood Institute. Expert panel report 3: guidelines for the diagnosis and management of asthma. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. The asthma control test and asthma control questionnaire for assessing asthma control: systematic review and meta-analysis.

Respir Med. A cluster randomised control trial to evaluate the effectiveness and cost-effectiveness of the Italian medicines use review I-MUR for asthma patients. Effectiveness of fluticasone furoate plus vilanterol on asthma control in clinical practice: an open-label, parallel group, randomised controlled trial. Concordance between the new questionnaires to evaluate asthma control.

Eur Respir J. Google Scholar. Exhaled breath condensate nitrates, but not nitrites or FENO, relate to asthma control. The comparison of three asthma control questionnaires and peak expiratory flow variability. Asthma control test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists.

Asthma control test and asthma control questionnaire: factorial validity, reliability and correspondence in assessing status and change in asthma control. J Asthma. Validity of asthma control test for asthma control assessment in Chinese primary care settings.

Professionals & Patients

Providing guideline-driven, top-notch asthma care and improving the quality of life for every person who lives with asthma should be the goal of health care professionals treating asthma patients. Clinical guidelines give health care providers the tools and information they need to diagnose, treat, and teach effective self-management skills to their patients and their families. Asthma care is a partnership and a shared responsibility between the patient, the health care provider, and the systems supporting them. Asthma can be controlled through effective asthma management using the guiding principles of patient-centered care 1. Asthma action plans AAPs are written, individualized self-management and educational tools that provide daily and emergency guidance to asthma patients, parents, and caregivers at home, school, and the workplace and community settings. Home visits can provide asthma care that meets the medical and educational needs of the individual patient. Projects conducted by MDH have repeatedly demonstrated the effectiveness of home-based services that include both asthma self-management education and home environmental assessments for people with asthma.

Here, you'll find data showing how our facilities score on industry standard measures for patient safety, health care outcomes, quality of care, and patient satisfaction and access to care. Search for your military treatment facility below to see how we're doing and how we measure our performance. Several national websites, operated separately from the MHS, have information about the quality of care in hospitals across the U. You can use Hospital Compare, Quality Check, or Leapfrog to find hospitals and compare the quality of their care. Go to Hospital Compare. Quality Check. Part of our transparency efforts include getting feedback from the community we serve.

Metrics details. However, the relationships between ACT score and other measures of asthma impact are not fully understood. Here, we evaluate how ACT scores relate to other clinical, patient-reported, or economic asthma outcomes. A targeted literature search of online databases and conference abstracts was performed. A total of publications were identified, 74 of which were included in the final analysis. Of these, 69 studies found that improvement in ACT score was related to improvement in outcome s , either as correlation or by association.

Clinical Guidelines, Standards & Quality of Care

Search this site. Achtsamkeitstagebuch PDF. Advances in CO 2 Corrosion: v.

MHS Quality, Patient Safety, and Access Information (for Patients)

States are in a unique position to play a central role in quality improvement efforts than can transform health care systems, reduce costs, and improve public health. In addition, a number of States already have begun demonstrations or other programs to improve the quality of asthma care. To assist such efforts, AHRQ has released the following products:.

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