PTE Pediatric Asthma Metrics Reporting
The Maine Health Management Coalition’s (MHMC) Pathways to Excellence (PTE) initiative is
updating its pediatric asthma metrics. Current ratings on the MHMC website (www.getbettermaine.org)
using the previous metrics, will expire on July 1, 2013. Practices have now through May 17, 2013, to
submit their new data using the process as outlined below. Practices submitting data on these
measures by May 17, 2013 can have their new ratings updated for July 1, 2013.
Practice Name: _____________________________
Date: _____________________________
Practice Address: ______________________________
Date:
Person Completing: _________________________
Phone: _____________________________
Responsible Clinician:________________________
Signature: ___________________________
________________________________
PTE Pediatric Asthma Metrics and Scoring, Updated September 2012
Asthma Measures
NUMERATOR
DENOMINATOR (Note:
for practices doing
manual chart review,
must be > 10 charts
for ages 2<5 and > 20
charts for ages 5<19
Practice Rate
1. Asthma Assessment
Max Points
for Measure
Practice Points
Achieved(Practice
Rate multiplied by
Maximum Points
Available)*
15
2. Lung Function Testing
(Note: Ages 5<19)
3. Medication Therapy
15
15
4. Influenza Vaccination
15
5. Patient Self Management Plan
15
6 Documented Tobacco
Exposure/Use
7. BMI %
15
10
Sub-Total Points Available/Received
8. Population Based Reporting-EMR/Registry for all asthmatics?
Yes/No
100
Yes = 10
No = 0
Total points for Population-Based reporting (if applicable)
* The points for each category are rounded to the next whole number.
** Best is only achievable for those reporting their total population regardless of the final score.
MHMC Rating (Good, Better, Best) Good > 45 Points Better > 65 Points ** Best > 75 Points 
PTE Asthma Specifications and Targets
1
The PTE Physician Steering Committee recognizes that lung function testing has not been utilized as
much as NHLBI guidelines recommend. Therefore, accommodations in scoring were made to allow
practices to obtain the best rating in 2013 while working to bring their lung function testing rates up to
guidelines. (See Sample Scoring Below)
PTE Pediatric Asthma Metrics – Example
Asthma Measures
from Chart Submission
NUMERATOR
DENOMINATOR (Note:
for practices doing
manual chart review,
must be > 10 charts
for ages 2<5 and > 20
charts for ages 5<19
Practice Rate
Max Points
for Measure
Practice Points
Achieved(Practice
Rate multiplied by
Maximum Points
Available)*
40
50
80%
15
12
10
20
50%
15
8
45
50
90%
15
14
38
50
76%
15
11
38
50
76%
15
11
38
50
76%
15
11
45
50
90%
10
9
100
76
Yes = 10
No = 0
0
1. Asthma Assessment
2. Lung Function Testing
(Note: Ages 5<19)
3. Medication Therapy
4. Influenza Vaccination
5. Patient Self-Management Plan
6 Documented Tobacco
Exposure/Use
7. BMI %
Sub-Total Points Available/Received
8. Population Based Reporting-EMR/Registry for all asthmatics?
Yes/No
Total points for Population-Based reporting (if applicable)
76
* The points for each category are rounded to the next whole number.
** Best is only achievable for those reporting their total population regardless of the final score.
MHMC Rating (Good, Better, Best) Good > 45 Points Better > 65 Points ** Best > 75 Points 
SUBMISSION INSTRUCTIONS:
1. Complete form and have responsible clinician sign.
2. Send to Maine Health Management Coalition either by fax or scan and email:
207-899-3207
Email to pte@mehmc.org
a. FAX:
b.
3. Responsible clinician signs attestation form (agrees to the validation of results and reporting
methodology).
PTE Asthma Specifications and Targets
2
4. Practice agrees to participate in an on-site validation of the data, upon MHMC’s request.
5. If possible, practice reports from registry or EMR. If none of these choices are available, then a chart
review can be done. Note: There must be a minimum of 10 patient charts reviewed for ages 2<5 and
20 patient charts reviewed for ages 5< 19 (a total of at least 30 charts).
6. Recognition will be effective for 2 years from the date of submission and the practice agrees to be
publically reported on the www.getbettermaine.com reporting website.
7. Practices who do not meet the lowest level of scoring criteria (<45 points) will be notified and reported
as “Did not Report” on the aforementioned reporting website. These practices can resubmit data 6
months from the date of the initial submission.
8. If desired, practices who currently have the PTE good or better rating may resubmit for a higher rating
prior to their expiration date.
INCLUSION CRITERIA
An eligible asthma patient is one who meets all three of the following criteria:
1. Is between the ages of 2 and <19 years of age on the last day of the reporting period.
2. Has been under the care of the participating practice for at least 24 months. This is defined as at least two
face-to-face office visits with a physician, physician's assistant, or nurse practitioner with one visit in each
measurement year. (Encounter CPT codes: 99201-99205, 99212-99215, 99241-99245, 99383-99386, and
99393-99396)
3. Patient has a documented diagnosis of asthma (ICD-9 Dx Codes: 493.00-493.02, 493.10-493.12, 493.20493.22, 493.80-493.82, and 493.90-493.92)
(Above Criteria is from the American Medical Association Measure Steward guidance on ASTHMA: Algorithm for
Measure Calculation-EHRS [Analytic Narrative and Data Elements])
4. Include all patients regardless of payer (e.g. commercial, Medicare, Medicaid, self-pay, uninsured, etc.).
5. Practices can include patients that are primarily managed by subspecialists for asthma in their data set.
6. Providers should clinically verify that all the patients meet the National Heart, Lung, and Blood Institute
(NHLBI) definition for asthma (as defined in "Definitions" in specifications document).
7. Practices are encouraged to submit population based data on all patients that meet criteria in their practice.
Only practices that submit population data from EHR, registry or claims can attain a "best" rating. Practices that
are doing chart review will be expected to submit data on at least 30 patients. (10 for ages 2 <5 and 20 for ages
5< 19.) If this minimum is not met for your practice, please include an explanation with your submission
materials.
PTE Asthma Specifications and Targets
3
#
Maine Health Management Coalition Pathways to Excellence:
Asthma Measure Specifications Revised September 2012
Measure Name
PTE Measure Description and
Criteria
Numerator (N)
Denominator (D)
Asthma
Assessmenti: % of
patients with
diagnosis of asthma
ages 2 and <19, who
were evaluated during
at least one office
visit within 12 mo for
daytime and
nocturnal asthma
symptoms.
Lung Function
Testingii:
% of patients with
diagnosis of asthma
ages 5 and <19 yo in
which one or more
spirometry result(s)
have been obtained
within the past 24
months
Numerator: Total number of children 2<19
yo with a diagnosis of asthma who were
evaluated within 12 mo for the frequency
(numeric) of daytime and nocturnal asthma
symptoms.
Denominator: Patients between the ages of
2 and <19 years who have been under the
care of the participating practice for at least
24 months and have a documented
diagnosis of asthma.
For asthma control tests,
these tools are validated:
Test for Respiratory and
Asthma Control in Kids
TRACK 2 < 4 years of
age, and
Asthma Control Test ACT
≥ 4 years of age
Numerator: Number of patients 5 <19 yo
who have had spirometry completed at least
once in the last 24 mo.
Denominator: Patients between the ages of
5 and <19 years who have been under the
care of the participating practice for at least
24 months and have a documented
diagnosis of asthma.
Will need to document that
some children are
physically unable to
perform test
3
Medication
Therapyiii:
% of patients ages 2
and <19 yo who were
identified as having
persistent asthma and
were appropriately
prescribed controller
medication
Numerator: Total number of patients age
2<19 identified with persistent asthma who
were appropriately prescribed controller
medication within the last 12 mo.
Denominator: Patients between the ages of
2 and <19 years who have been under the
care of the participating practice for at least
24 months and have a documented
diagnosis of persistent asthma.
4
Influenza
Vaccinationiv:
% of patients with
diagnosis of asthma
ages 2 and <19 yo
Numerator: Total number of patients ages
2<19 yo with flu shot documented within
the last 12 mo
Denominator: Patients between the ages of
2 and <19 years who have been under the
1
2
PTE Asthma Specifications and Targets
Moderate or Severe
Persistent Asthmatics may
need to have lung function
testing done more
frequently than every 2
years; this metric will
capture that all asthmatics
should have lung function
testing at least every 2
years
.
Need to document
contraindications (included
in BTE metric)
ACIP: Recommends
influenza vaccination for
4
who have a
documented flu shot
within the past 12 mo
care of the participating practice for at least
24 months and have a documented
diagnosis of asthma.
all >6 months and when
supply is limited focus on
those with chronic
pulmonary disease
(including asthma), among
others.
5
Patient SelfManagement Planv:
% of patients with
diagnosis of asthma
ages 2 and <19 yo,
that have a current
written action plan on
file updated within
the last year
Numerator: Number of patients 2<19 yo
with a written action plan updated within
the last 12 mo.
Denominator: Patients between the ages of
2 and <19 years who have been under the
care of the participating practice for at least
24 months and have a documented
diagnosis of asthma.
An asthma action plan
(also called a management
plan) is a written plan that
is developed by a provider
with a family that outlines
a patient’s medical therapy
and asthma symptoms that
warrant further treatment
or action
6
Tobacco Exposure
and Use:
% of patients with
diagnosis of asthma
ages 2 and <19 yo
with annual
documentation of
tobacco exposure/
tobacco use
Numerator: Total number of children ages
2 and <19 yo with documentation of
tobacco exposure and for children ages 10
and <19 assessed for tobacco use within the
last 12 mo.
Denominator: Patients between the ages of
2 and <19 years who have been under the
care of the participating practice for at least
24 months and have a documented
diagnosis of asthma.
Tobacco exposure is
defined as someone who
uses tobacco who lives in
the household or is a
primary caregiver.
7
BMI %vi:
% patients % of
patients with
diagnosis of asthma
ages 2 and <19 yo
with BMI%
documented
Numerator: Patients 2<19yo who have
evidence of Body Mass Index (BMI)
percentile documentation within the last 12
mo.
Denominator: Patients between the ages of
2 and <19 years who have been under the
care of the participating practice for at least
24 months and have a documented
diagnosis of asthma
i
Adapt Meaningful use, NQF #001, AMA (Currently ages 5-40)
ii
Adapt BTE Lung Function and Spirometry Metric (Currently ages 5-75 and yearly evaluation)
NHLBI 2007 Guidelines: The Expert Panel recommends the following frequencies for spirometry
measurements:
PTE Asthma Specifications and Targets
5
(1) at the time of initial assessment (Evidence C); (2) after treatment is initiated and symptoms and
PEF have stabilized, to document attainment of (near) “normal” airway function; (3) during a period
of progressive or prolonged loss of asthma control; and (4) at least every 1–2 years to assess the
maintenance of airway function (Evidence B, extrapolation from clinical trials). Spirometry may be
indicated more often than every 1–2 years, depending on the clinical severity and response to
management (Evidence D). These spirometry measures should be followed over the patient’s lifetime
to detect potential for decline and rate of decline of pulmonary function over time (Evidence C).
iii
Adapt Meaningful use /NQF #0036 (Currently ages 5-11, 12-50)
iv
Adapt BTE Influenza Vaccination Metric (Currently ages 5 -75 years)
v
Adapt BTE Patient Self-Management Plan Metric (Currently ages 5-75 years)
vi
Adapt BTE Body Mass Index Metric (Currently Percentage of patients ages 18-75)
DEFINITIONS
Asthma:
To establish a diagnosis of asthma, the clinician should:
- Use a medical history and exam to determine that symptoms of variable and recurrent episodes of
airflow obstruction, airway hyper responsiveness, and underlying inflammation are present. In
susceptible individuals, this inflammation causes recurrent episodes of coughing (particularly at night
or early in the morning), wheezing, breathlessness, and chest tightness. (Source: p. 9 of Abridged NHLBI
Guidelines)
- Use spirometry in all patients 5 years or greater to determine the level of airflow obstruction and
assess reversibility
- Exclude alternative diagnoses (Upper Airway Disease- allergic rhinitis and sinusitis; Obstruction of
the large airways: foreign body in trachea or bronchus, vocal cord dysfunction, vascular ring or
laryngeal web, laryngotracheomalacia, tracheal stenosis, or broncheostenosis, enlarged lymph node or
tumor; Obstructions involving small airways: viral bronchiolitis or obliterative bronchiolitis, cystic
fibrosis, bronchopulmonary dysplasia, heart disease; Other causes: recurrent cough not due to asthma,
aspiration from swallowing mechanism dysfunction or gastroesophageal reflux) (Source: Differential
Diagnosis for Asthma, AH! Program Flipchart, p. 3)
Persistent Asthma:
- Symptoms >2 days per week OR
- Awaken at night from asthma 1-2X per month for children ages 2 <5 years and >2X per month ages 5
<19 years OR
- Limitation of activities, despite pretreatment for exercise induced asthma OR
- More than 2 steroid bursts in 1 year OR
- FEV1 <80% predicted OR low FEV1/FVC ratio
PTE Asthma Specifications and Targets
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