Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E)

The percentage of persons 5-64 years of age with an urgent care visit, acute inpatient discharge, observation stay discharge or ED visit with a diagnosis of asthma that had a corresponding outpatient follow-up visit with a diagnosis of asthma within 30 days.

Why It Matters

This measure focuses on improving poor and disparate asthma outcomes by encouraging the use of outpatient follow-up care after an asthma exacerbation.

Asthma is a complex, chronic disease that occurs in all ages. If poorly controlled or triggered by an environmental factor, it can result in episodic exacerbations with significant health and financial consequences. While asthma exacerbations are medical emergencies requiring acute interventions, they may be avoided using preventive care.

In 2021, 6.5% of children and 8% of adults in the United States had asthma and the disease was responsible for 3,517 deaths 1. When prevalence was stratified by race/ethnicity, Black individuals were more likely to experience disease burden than non-Hispanic White individuals 7 8 9. Between 2019 and 2038, 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, with per capita costs ranging from $2,209 to $6,132 2.

In non-emergent outpatient settings, providers can develop asthma care plans, assign treatments, and monitor symptoms in the context of a continuing patient/provider relationship 3. However, recent research indicates that provider shortages and other non-clinical factors (e.g., socioeconomic status, environmental exposures, access to care) often bar individuals from being able to access these preventive care settings. Without a touchpoint for ongoing outpatient services, individuals may not receive treatment for their asthma until they experience an exacerbation that requires acute care 4.

Acute care settings such as emergency departments, inpatient hospitals and urgent care are well-equipped for medical emergencies but are limited in their ability to deliver the longitudinal care that recent clinical guidelines recommend for asthma care 5 6. As such, an overreliance on these care settings can result in poor outcomes despite high health care utilization. Patients who are experiencing this fragmented care in emergent, outpatient settings can benefit from a follow-up with a healthcare provider to assess risk factors and discuss longitudinal asthma care plans 10.

The Global Initiative for Asthma published updates to asthma care guidelines, which includes recommendations for follow-up by a healthcare provider after experiencing an acute exacerbation event 5. The guidance recommends that, post-exacerbation event, the healthcare provider should assess for symptom resolution and lung functionality 5. Providers should also assess for risk factors, explore potential exacerbation triggers and assess the patient’s existing long-term treatment plan or discuss creating one if one does not exist 5.

Historical Results – National Averages

Performance results for this measure are currently unavailable.

References

  1. Centers for Disease Control and Prevention. Most Recent National Asthma Data. Asthma. May 10, 2023. Accessed October 15, 2024. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm
  2. Yaghoubi M, Adibi A, Safari A, FitzGerald JM, Sadatsafavi M. 2019. “The Projected Economic and Health Burden of Uncontrolled Asthma in the United States.” Am J Respir Crit Care Med. 200(9):1102-1112. doi:10.1164/rccm.201901-0016OC
  3. Wu TD, Brigham EP, McCormack MC. 2019. “Asthma in the Primary Care Setting.” Med Clin North Am. 103(3):435-452. doi:10.1016/j.mcna.2018.12.004
  4. Haughney J, Winders TA, Holmes S, et al. 2020. “Global Quality Standard for Identification and Management of Severe Asthma.” Adv Ther. 37(9):3645-3659. doi:10.1007/s12325-020-01450-7
  5. National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. 2020. “2020 Focused Updates to the Asthma Management Guidelines.” U.S. Department of Health and Human Services National Heart, Lung, and Blood Institute; 2020. Accessed September 12, 2024. https://www.nhlbi.nih.gov/resources/2020-focused-updates-asthma-management-guidelines
  6. Global Initiative for Asthma. 2024. “2024 Global Strategy for Asthma Management and Prevention.” Global Initiative for Asthma; 2024. Accessed September 13, 2024. https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf
  7. Forno E, Ortega VE, Celedón JC. 2023. “Asthma and Chronic Obstructive Pulmonary Disease.” Clin Chest Med. 44(3):519-530. doi:10.1016/j.ccm.2023.03.008
  8. Pate CA, Qin X, Johnson C, Zahran HS. 2023. “Asthma disparities among U.S. children and adults.” J Asthma Off J Assoc Care Asthma. Published online July 10, 2023:1-10. doi:10.1080/02770903.2023.2228915
  9. Siegel M, Rieders M, Rieders H, et al. 2023. “Structural racism and racial health disparities at the state level: A latent variable approach.” J Natl Med Assoc. 115(4):338-352. doi:10.1016/j.jnma.2023.07.003
  10. AstraZeneca, NCQA. 2024. “Improving Outcomes for People with Asthma: Challenges & A Call to Action [White paper].” Accessed March 25, 2024. https://wpcdn.ncqa.org/www-prod/wp-content/uploads/2024-NCQA-Asthma-Whitepaper-Final-LR.pdf

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