ABIM Asthma PIM™ Practice Improvement Module Measures Catalogue

ABIM Asthma PIM™ Practice Improvement Module
Measures Catalogue

Asthma PIM
Measures Catalog
September 2010

TABLE OF CONTENTS

Introduction .............................................................................................................................................................. 3

Outcomes of Care ................................................................................................................................................... 5

Processes of Care.................................................................................................................................................... 6

Patient Experience: Outcomes of Care .............................................................................................................. 12

Patient Experience: Processes of Care ............................................................................................................. 14

Asthma Measure Catalog September 2010 Page 2 of 19

Introduction

This catalogue provides information related to the American Board of Internal Medicine’s Asthma Practice Improvement
Module®. It is written in language that addresses the physician who might choose to complete this module, and it details the
specifics of the module. Included is information regarding:

• Purpose and structuring of the module
• Patient inclusion criteria
• Detailed description of the measures

This PIM examines the care you provide to your patients by addressing key processes and outcomes of asthma care based on
recommendations of the Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma. The EPR 3
Guidelines on Asthma were developed by an expert panel commissioned by the National Asthma Education and Prevention Program
(NAEPP) Coordinating Committee, under the auspices of the National Heart, Lung, and Blood Institute (NHLBI) of the National
Institutes of Health.

The PIM is divided into three parts, with multiple sections in each part.

Part 1 -Performance Data
Provide baseline data about your practice's current performance by...

• Surveying your patients
• Reviewing your charts
• Assessing your practice systems

The 23 patient survey measures and 21 chart review measures are summarized below. ABIM recommends a minimum of 25 patient
surveys and 25 chart reviews. If you have extreme difficulty meeting this recommendation in a reasonable time frame, you may
satisfy this requirement with only ten surveys and ten charts.

The practice systems assessment comprises questions covering various aspects of practice structure and protocols.


Patients can be included in this module if all of the following are true:

1. They are between the ages of 15 and 90 (inclusive);
2. Management decisions regarding their asthma are made primarily by providers in the practice;
3. They have been patients in the practice for at least one year; AND
4. They have been seen by the practice within the past 12 months.

Patients should be excluded from this module if either of the following is true:

1. They are unable to complete the patient survey, even with assistance
OR
2. They have a terminal illness, or treatment of their asthma is not clinically relevant.

Part 2 - Quality Improvement (QI) Plan
Develop a plan for improving one aspect of your practice after reviewing the analysis of your current performance data. The analysis
will include many aspects of care you provide to your patients. Ultimately, you will target only one of these to use in this quality
improvement (QI) cycle.

Part 3 - Remeasurement
Remeasure your performance data after you have implemented your QI plan to see if you achieved your goal. Then, you will reflect on
the process of developing and implementing a QI plan.

You may claim CME credit for completing this activity. The University of Pennsylvania School of Medicine designates this
educational activity for a maximum of 20 AMA PRA Category 1 Credit(s)TM.


Asthma - OUTCOMES OF CARE

Clinical Outcomes

Measure Title Description Numerator Denominator Rationale

Patient has minimal Patients in the sample who Number of patients in the sample Number of patients Frequency of symptoms is an
asthma symptoms experienced severe asthma who experienced severe asthma in the sample important indicator of asthma
symptoms twice a week or less, symptoms twice a week or less, severity and adequacy of control.
during the month prior to the during the month prior to the Patient who report an increase in
most recent visit most recent visit frequency or severity of symptoms
may require more intensive
treatment.

Patient has minimal Patients in the sample who Number of patients in the sample Number of patients Nocturnal symptoms are common in
nighttime asthma experienced nighttime asthma who experienced nighttime in the sample asthma and should be addressed in
symptoms symptoms twice a week or less, asthma symptoms twice a week a patient's management plan. The
during the month prior to the or less, during the month prior to frequency of nighttime awakenings
most recent visit the most recent visit is an important indicator of disease
severity and adequacy of control.

Most recent FEV1 > Patients in the sample who had Number of patients in the sample Number of patients
80% predicted spirometry done during the 24- who had spirometry done during in the sample
month abstraction period, or the 24-month abstraction period,
three months prior to the or three months prior to the
abstraction period, and whose abstraction period, and whose
FEV1 was >80% predicted FEV1 was >80% predicted

0-1 exacerbation Patients in the sample who had Number of patients in the sample Number of patients Patients whose asthma is well
requiring oral systemic 0-1 exacerbation requiring oral who had 0-1 exacerbation in the sample controlled typically have fewer
corticosteroids within systemic corticosteroids within requiring oral systemic exacerbations. When exacerbations
past 12 months the past 12 months corticosteroids within the past 12 do occur, oral systemic
months corticosteroids may be appropriate,
except for the most mild and most
severe episodes. Short courses
have been shown to shorten the
duration of episodes and may
prevent hospitalization and relapse.


ASTHMA - PROCESSES OF CARE

Patient Evaluation


History of factors and Of the total number of responses Of the total number of responses Number of total A complete medical evaluation
exposures that make for all patients in the sample, the for all patient in the sample, the responses to should be performed to classify
asthma symptom “Assessed” responses to number of “Assessed” responses questions about asthma, detect the presence of
control more difficult questions about various factors to questions about various whether various complications, and assess risk
and exposures that make control factors and exposures that make factors and factors in patients with established
of asthma symptoms more control of asthma symptoms exposures make asthma. This information will assist
difficult (chronic exposure to more difficult (chronic exposure control of asthma in formulating a management plan
second-hand smoke; recurrent to second-hand smoke; recurrent symptoms more and provide a basis for continuing
rhinitis and/or sinusitis; nasal rhinitis and/or sinusitis; nasal difficult and to the care.
polyps; gastroesophageal reflux; polyps; gastroesophageal reflux; question about
aspirin or NSAID sensitivity; aspirin or NSAID sensitivity; current smoking
exercise-induced bronchospasm; exercise-induced bronchospasm; status
fur-bearing pets in the home; fur-bearing pets in the home;
moisture, dampness, or visible moisture, dampness, or visible
mold in the home; cockroaches mold in the home; cockroaches
in the home; outdoor allergens; in the home; outdoor allergens;
workplace exposures; workplace exposures;
stressors/stressful situations; stressors/stressful situations;
depression; weather changes) depression; weather changes)
and “Yes” or “No” responses for and “Yes” or “No” responses for
current smoking status current smoking status

Asthma severity Patients in the sample whose Number of patients in the sample Number of patients Classification of asthma severity is
classification asthma severity classification is for whom asthma severity in the sample essential when initiating treatment.
documented documented classification is documented Severity is best assessed in patients
who are not using long-term control
therapy. The two principle components
of assessment are impairment (i.e.,
frequency and intensity of symptoms,
functional limitations) and risk (i.e.,
likelihood of exacerbation or loss of lung
function). A detailed classification
scheme has been developed by the
National Asthma Education and
Prevention Program (NAEPP) of the
National Heart, Lung, and Blood Institute
(NHLBI); refer to the Expert Panel
Report 3 (EPR3): Guidelines for the
Diagnosis and Management of Asthma.



Diagnostic Testing


Spirometry at any time Patients in the sample who had Number of patients in the sample Number of patients Spirometry is recommended as part
spirometry done and whose who had spirometry done and in the sample of the initial patient evaluation, after
results were documented whose results were documented therapy has begun and symptoms
have stabilized, during times of
increased symptoms and/or poor
control, and at least every one to
two years. More frequent testing
may be appropriate for patients with
severe asthma and those who have
a poor response to therapy.

Spirometry within past Patients in the sample who had Number of patients in this Number of patients Spirometry is recommended as part
two years spirometry done during the 24- sample who had spirometry in the sample of the initial patient evaluation, after
month abstraction period, or done during the 24-month therapy has begun and symptoms
three months prior to the abstraction period, or three have stabilized, during times of
abstraction period, and whose months prior to the abstraction increased symptoms and/or poor
results were documented period, and whose results were control, and at least every one to
documented two years. More frequent testing
may be appropriate for patients with
severe asthma and those who have
a poor response to therapy.

Office PEFR Patients in the sample whose Number of patients in the sample Number of patients A diagnosis of asthma is suggested
peak expiratory flow rate (PEFR) whose PEFR has been in the sample when office measurement of PEFR
has been measured in the office measured in the office and yields a value below the predicted.
and results documented results documented The finding is not diagnostic,
however. Improvement in PEFR
after use of a bronchodilator
provides further support for the
diagnosis of asthma. PEFR values
also can provide information to
assist in monitoring asthma control,
but they are not reliable measures
of disease severity.



Diagnostic Testing (cont.)


Allergy testing at any Patients in the sample who had Number of patients in the sample Number of patients While patient history generally is
time allergy testing done and whose who had allergy testing done and in the sample sufficient to determine sensitivity to
results were documented whose results were documented seasonal allergens, allergy testing
(skin or in vitro) usually is needed to
determine sensitivity to perennial
indoor allergens. Patients should be
tested only for allergens to which
they may be exposed, and clinicians
should assess the relevance of any
sensitivities that are noted. Test
results also are an important
element of patient education,
specifically avoiding exposures.

Treatment


Short-acting beta Patients in the sample for whom Number of patients in the sample Number of patients Short-acting beta agonists (SABAs)
agonists (SABAs) SABAs are prescribed, except for whom SABAs are prescribed, in the sample, are the treatment of choice for acute
prescribed for all those with a contraindication to except those with a except those with a asthma symptoms and
patients SABAs contraindication to SABAs contraindication to exacerbations. They typically
SABAs provide relief within 3-5 minutes.
Routine scheduled daily use of
SABAs is not recommended.

Appropriate treatment Patients in the sample with Number of patients in the sample Number of patients Patients who have asthma
for intermittent asthma intermittent asthma for whom with intermittent asthma for in the sample with symptoms (daytime or nocturnal
SABAs are prescribed, except whom SABAs are prescribed, intermittent asthma, awakenings) on two days per week
those with a contraindication to except those with a except those with a or fewer, with no disruption of
SABAs, but for whom long-term contraindication to SABAs, but contraindication to normal activity, can be classified as
control medication was NOT for whom long-term control SABAs having intermittent asthma. Further,
prescribed medication was NOT prescribed such patients should require use of
a short-acting beta agonist (SABA)
on two days per week or fewer.


ASTHMA – PROCESSES OF CARE

Treatment (cont.)


Appropriate treatment Patients in the sample with Number of patients in the sample Number of patients Patients with persistent asthma
for persistent asthma persistent asthma for whom both with persistent asthma for whom in the sample with require both a long-term control
SABAs and long-term control both SABAs and long-term persistent asthma, medication and a short-acting
medication, other than a LABA control medication, other than a except those with a medication to relieve acute
alone, are prescribed, except LABA alone, are prescribed, contraindication to symptoms. LABAs should be used
those with a contraindication to except those with a SABAs as adjunctive therapy, with an
SABAs contraindication to SABAs inhaled corticosteroid.

Inappropriate use of Patients in the sample with Number of patients in the sample Number of patients LABAs should be used as
long-acting beta persistent asthma for whom only with persistent asthma for whom in the sample with adjunctive therapy, with an inhaled
agonists (LABAs) a LABA is prescribed only a LABA is prescribed persistent asthma corticosteroid. They are not
and who have long- appropriate to treat acute symptoms
term control or exacerbations, nor as
medication as part of monotherapy for long-term control
their treatment plan of persistent asthma.
Patient uses short- Patients in the sample for whom Number of patients in the sample Number of patients Frequent use (>= 2 days/week) of a
acting beta2-agonist <= a SABA is prescribed for quick for whom a SABA is prescribed in the sample for SABA for quick relief of asthma
2 days/week relief of asthma symptoms and for quick relief of asthma whom a SABA is symptoms is a marker of poor
who use it two days or less per symptoms and who use it two prescribed for quick control.
week days or less per week relief of asthma
symptoms

Preventive Care


Influenza vaccine Patients in the sample who Number of patients in the sample Number of patients Influenza is a common, preventable
during most recent flu received influenza vaccination who received influenza in the sample infectious disease associated with high
season during the most recent flu vaccination during the most mortality and morbidity in the elderly and
in people with chronic diseases.
season recent flu season
Observational studies of patients with a
variety of chronic illnesses, including
asthma, show an increase in
hospitalizations for influenza and its
complications. Influenza vaccine is
widely underutilized in patients with
asthma.



Preventive Care (cont.)


Smoking-cessation Patients in the sample who are Number of patients in the sample Number of patients A number of large randomized
counseling at most smokers and who received who are smokers and for whom in the sample who clinical trials have demonstrated the
recent visit smoking-cessation counseling or smoking-cessation counseling or are smokers efficacy and cost-effectiveness of
treatment at their most recent treatment was documented at smoking-cessation counseling in
visit their most recent visit changing smoking behavior and
reducing tobacco use.

Smoking cessation Patients in the sample who are Number of patients in this Number of patients A number of large randomized
counseling within past smokers and who received sample who are smokers and for in this sample who clinical trials have demonstrated the
12 months smoking-cessation counseling or whom smoking-cessation are smokers efficacy and cost-effectiveness of
treatment during the 12-month counseling or treatment was smoking-cessation counseling in
abstraction period documented during the 12- changing smoking behavior and
month abstraction period or reducing tobacco use.
three months prior to the
abstraction period

Patient Self-Care Support


Patient has written Patients in the sample who have Number of patients in the sample Number of patients All asthma patients should have a
asthma management a written asthma-management who have a written asthma- in the sample written action plan that includes
plan plan management plan both daily management, as well as
how to recognize and handle
worsening symptoms. The patient
and physician should agree upon
the plan, thus involving the patient
directly in self-management. Written
plans may be particularly important
for patients who have moderate or
severe persistent asthma, severe
exacerbations, or poorly controlled
asthma. Patients should be given a
copy of their plan, which should be
reviewed at every visit.



Patient Self-Care Support (cont.)


Plan was created, Patients who had a written Number of patients in the sample Number of patients All asthma patients should have a
updated and/or asthma-management plan who had a written asthma- in the sample written action plan that includes
reviewed at most recent created, updated, and/or management plan created, both daily management, as well as
visit reviewed at the most recent visit updated, and/or reviewed at their how to recognize and handle
most recent visit worsening symptoms. The patient
and physician should agree upon
the plan, thus involving the patient
for patients who have moderate or

Written copy of Patients in the sample who were Number of patients who were Number of patients
management plan at given a written copy of their given a written copy of their in the sample whose
most recent visit asthma management plan asthma management plan written asthma-
management plan
was created,
updated, or reviewed
at their most recent
visit


PATIENT EXPERIENCE: ASTHMA – OUTCOMES OF CARE

Clinical Outcomes


Patient has minimal Patients in the sample who Number of patients who Number of patients Nocturnal symptoms are common in
nighttime asthma reported that their asthma did responded “No” to the Survey who completed a asthma and should be addressed in
symptoms – PtSrv not wake them up at night question “In the past four weeks, survey a patient’s management plan. The
did your asthma wake you up at frequency of nighttime awakenings
night?” is an important indicator of disease
severity and adequacy of control.

Patient states asthma is Patients in the sample who Number of surveyed patients Number of patients The goals of asthma treatment are
well controlled report that their asthma is well who responded “Yes” to the who completed a twofold: 1.) to decrease impairment,
controlled question “In the past four weeks, survey including frequency and severity of
did you feel that your asthma both daytime and nocturnal
was well controlled?” symptoms, infrequent use of SABAs
for acute symptoms, and normal
activity levels; and 2.) to decrease
the risk of exacerbations, ED visits,
hospitalizations, and progressive
loss of function. Physicians should
assess patient expectations and
work closely with patients to
improve self-management skills and
compliance.

No ER visits for asthma Patients in the sample who Number of surveyed patients Number of patients In general, more frequent and
in past year report having no ER visits for who responded “None” to the who completed a intense exacerbations (e.g.,
asthma during the past year question, “In the past 12 months, survey requiring urgent, unscheduled care,
how many times did you go to hospitalization, or ICU admission)
the emergency department indicate greater underlying disease
because of your asthma severity.
symptoms?”


PATIENT EXPERIENCE: ASTHMA – OUTCOMES OF CARE

Functional Outcomes and Self-Care


No activities missed Patients in the sample who Number of surveyed patients Number of patients A patient's ability to maintain normal
because of asthma report missing no activities who responded "No" to the who completed a activity levels, including exercise
because of asthma question, "In the past 4 weeks, survey and attendance at work or school, is
did you miss any work, school, an important indicator of disease
or normal daily activity (for severity and control.
example, household chores or
social engagements) because of
your asthma?"

Good fitness level Patients in the sample who Number of surveyed patients Number of patients An important measure of asthma
described their current level of who responded "Really in shape" who completed a severity and disease control is the
fitness as "Really in shape" or "In or "In shape" to the question survey patient's ability to maintain normal
shape" "How would you describe your activity levels. This includes
current level of fitness?" exercise and other physical activity,
as well as attendance at work or
school.

Patient Satisfaction


Patient rates asthma Patients in the sample who rate Number of patients who Number of patients The goals of asthma treatment are
care "excellent" their asthma care as "excellent" responded "Excellent" to the who completed a twofold: 1.) to decrease impairment,
survey question, "How would you survey including frequency and severity of
describe your overall asthma both daytime and nocturnal
care?" symptoms, infrequent use of SABAs
for acute symptoms, and normal
activity levels; and 2.) to decrease
the risk of exacerbations, ED visits,
hospitalizations, and progressive
loss of function. Physicians should
assess patient expectations and
work closely with patients to
improve self-management skills and
compliance.


PATIENT EXPERIENCE: ASTHMA – PROCESSES OF CARE

Treatment


Rescue inhaler alone Patients in the survey who Number of surveyed patients Number of patients Short-acting beta agonists (SABAs)
reported use of a short-acting reporting use of a short-acting who completed a are the most effective treatment for
beta agonist but no long-term beta agonist but no long-term survey acute symptoms. Routine scheduled
control medication control medication daily use is not recommended,
however. If SABAs are needed
more than two days per week (or
more than one canister per month),
asthma is considered to be poorly
controlled. Additional therapy should
be recommended. Excess use of
SABAs has been associated with an
increased risk for severe
exacerbations and death.
Rescue inhaler plus Surveyed patients reporting use Number of surveyed patients Number of patients Patients with persistent asthma
long-term control of a short-acting beta agonist reporting use of a short-acting who completed a require treatment with both a long-
medication and a long-term control beta agonist and a long-term survey term control medication and a quick-
medication control medication relief medication. Long-term control
medications include inhaled
corticosteroids (ICSs), inhaled long-
acting bronchodilators, leukotriene
modifiers, cromolyn, theophylline,
and immunomodulators. Of these,
ICSs have been shown to be the
most effective.

Long-term control Surveyed patients reporting use Number of surveyed patients Number of patients Patients with persistent asthma
medication alone of long-term control medication reporting use of long-term who completed a require treatment with both a long-
but no short-acting beta-agonist control medication but no short- survey term control medication and a quick-
acting beta-agonist relief medication. Long-term control
medications include inhaled
corticosteroids (ICSs), inhaled long-
acting bronchodilators, leukotriene
modifiers, cromolyn, theophylline,
and immunomodulators. Of these,
ICSs have been shown to be the
most effective.



Treatment (cont.)


Patient uses short- Patients in the sample who Number of surveyed patients Number of surveyed Frequent use (>= 2 days/week) of a
acting beta2-agonist <= report using a SABA inhaler two who report using a SABA inhaler patients who report SABA for quick relief of asthma
2 days /week - PtSrv days or less per week in the four two days or less per week in the using a SABA symptoms is a marker of poor
week prior to completing the four weeks prior to completing inhaler control.
survey the survey

Patient uses long-term Surveyed patients reporting use Number of surveyed patients Number of surveyed Patients with persistent asthma
control medication of long-term control medication reporting use of long-term patients who report require both a long-term control
every day every day control medication every day. that for whom an medication and a short-acting
asthma inhaler or pill medication to relieve acute
that is NOT used for symptoms. Long-term control
quick relief but is medications should be taken daily
used to control for maximum effectiveness.
asthma is
prescribed.

Preventive Care


Smoking cessation Patients in the sample who Number of patients in the sample Number of surveyed A number of large randomized
counseling - PtSrv responded "Yes, more than who responded "Yes, more than patients who are clinical trials have demonstrated the
once" to the survey question "If once" to the survey question "If smokers efficacy and cost-effectiveness of
you smoke, has your doctor you smoke, has your doctor smoking-cessation counseling in
advised you to stop?" advised you to stop?" changing smoking behavior and
reducing tobacco use.

Help to stop smoking Patients in the sample who Number of surveyed patients Number of surveyed
reported receiving assistance, who smoke and responded "Yes" patients who smoke
medication, or a referral to help to the survey question, "Did you
them stop smoking doctor offer you assistance,
medication, or a referral to help
you stop smoking?"



Patient Self-Care Support


Asthma attack Patients in the sample who Number of patients in the sample Number of patients All asthma patients should have a
report knowing what to do for an who responded "Yes" to the who completed a written action plan that includes
asthma attack survey question, "Do you have survey both daily management, as well as
written instructions from your how to recognize and handle
doctor or someone in the worsening symptoms. The patient
practice on what to do if you are and physician should agree upon
having an asthma attack?" the plan, thus involving the patient
for
patients who have moderate or

Inhaler use has been Patients in the sample who Number of patients in the sample Number of surveyed Experts recommend that a patient's
observed during past responded "Yes" to the survey who responded "Yes" to the patients who report inhaler technique be assessed at
year question, "In the past 12 months, survey question, "In the past 12 using an inhaler for every visit. This is an important
has your doctor or someone in months, has your doctor or quick relief from component of self-management
the doctor's office watched you someone in the doctor's office asthma symptoms education for all asthma patients.
use an inhaler to make sure you watched you use an inhaler to Elderly asthma patients may need
use it correctly?" make sure you use it correctly?" additional attention because inhaler
use can be compromised by
physical and/or cognitive
impairments.

Patient reports shared Patients in the sample who Number of patients in the sample Number of patients Care should be patient-centered,
decision-making about report that they share decision- who responded "Yes" to the who completed a respectful of and responsive to individual
asthma treatment making about their asthma survey question "Do you and survey patient preferences, needs, and values
and ensuring that patient values guide
treatment with their doctor your doctor share decision-
all clinical decisions. Patients' overall
making about your asthma experiences with doctors are shaped by
care?" communication style and content and
both contribute to the likelihood that a
patient will understand and be able to
follow treatment recommendations.





Practice is excellent at Patients in the sample who rated Number of patients who Number of patients Care should be patient-centered,
encouraging questions the practice "excellent" at responded "Excellent" to the who completed a respectful of and responsive to
and answering them encouraging questions and survey question, "How is this survey individual patient preferences,
clearly answering them clearly practice at encouraging needs, and values and ensuring
questions and answering them that patient values guide all clinical
clearly?" decisions. Patients' overall
experiences with doctors are
shaped by communication style and
content and both contribute to the
likelihood that a patient will
understand and be able to follow
treatment recommendations.

Practice is excellent at Patients in the sample who rated Number of patients who Number of patients Care should be patient-centered,
going over how to take the practice "excellent" at going responded "Excellent" to the who completed a respectful of and responsive to
asthma medications over how to take asthma survey question, "How is this survey individual patient preferences,
medications practice at going over how to needs, and values and ensuring
take your medications?" that patient values guide all clinical
decisions. Patients' overall

Practice is excellent at Patients in the sample who rated Number of patients in the sample Number of patients Care should be patient-centered,
providing information on the practice "excellent" at who responded “Excellent” to the who completed a respectful of and responsive to
side effects of providing information on side survey question, "How is this survey individual patient preferences,
medications effects of medications practice at providing information needs, and values and ensuring
on side effects of medications?" that patient values guide all clinical
decisions. Patients' overall





Practice is excellent at Patients in the sample who rated Number of patients in the sample Number of patients A variety of exposures can induce
reviewing asthma the practice "excellent" at who responded “Excellent” to the who completed a or trigger symptoms of asthma.
triggers reviewing asthma triggers patient survey question, "How is survey Common triggers include cigarette
this practice at reviewing asthma smoke, dust mites, air pollution, and
triggers?" pets. Triggers can be patient-
specific, so it is important that each
patient is aware of what his/her
triggers are and how they can be
avoided. This is a critical element of
patient self-management.

Access to Practice


Patient reports no Patients in the sample who Number of patients in the sample Number of patients A key expectation for many patients
problem with report no problems scheduling who responded "Not a problem" in the sample, is the ability to get medical care
scheduling appointments with the practice to the survey question, "In the excluding those who when they believe they need it.
appointments past 12 months, how much of a responded "Not
problem has it been to schedule applicable" to the
appointments with this practice?" survey question, "In
the past 12 months,
how much of a
problem has it been
to schedule
appointments with
this practice?"

Patient reports no Patients in the sample who Number of patients in the sample Number of patients in The Institute of Medicine (IOM)
problem with reaching report no problems reaching the who responded "Not a problem" the sample, excluding recommends that patients receive care
someone with a practice with questions or to the survey question, "In the those who responded whenever they need it and in many
"Not applicable" to the forms, not just face-to-face visits. This
question concerns past 12 months, how much of a
survey question, "In the implies that the health care system
problem has it been to reach this past 12 months, how should be responsive at all times (24
practice when you have a much of a problem has hours a day, every day) and that access
question or concern?" it been to reach this to care should be provided over the
practice when you Internet, by telephone, and by other
have a question or means in addition to face-to-face visits.
concern?"



Access to Practice (cont.)


Patient reports no Patients in the sample who Number of patients in the sample Number of patients The Institute of Medicine (IOM)
problem with obtaining report no problems obtaining who responded "Not a problem" in the sample, recommends that patients receive
prescription refills prescription refills to the survey question, "In the excluding those who care whenever they need it and in
past 12 months, how much of a responded "Not many forms, not just face-to-face
problem has it been to get a applicable" to the visits. This implies that the health
prescription refill from this survey question, "In care system should be responsive
practice?" the past 12 months, at all times (24 hours a day, every
how much of a day) and that access to care should
problem has it been be provided over the Internet, by
to get a prescription telephone, and by other means in
refill from this addition to face-to-face visits.
practice?"

© 2010 American Board of Internal Medicine. All rights reserved. ABIM publications are protected by United States and international copyright laws. Written permission for any reproduction or
adaptation, in whole or in part, in any format or medium must be obtained from ABIM. Contact request@abim.org.


ABIM Asthma PIM™ Practice Improvement Module Measures Catalogue

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