Chronic Urticaria/Angiodema Measures Comment Site

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Development of quality measures has become critical with the new healthcare environment that demands accountability and documentation of quality care. The AMA-Physician Consortium for Performance Improvement® (PCPI) has taken the lead on measure development and currently has developed measurement sets in 46 clinical areas and preventive care encompassing more than 280 individual measures. These measures are used by carriers and CMS to determine that a physician is practicing “quality” medicine. An overly simplified example is in the care of diabetics. One diabetic measure is whether the physician has obtained a HgbA1c within the past year. This must be documented in the medical record for the physician to receive appropriate reimbursement. For further information on measure development, please visit the AMA-PCPI website at http://www.ama-assn.org/ama/pub/physician-resources/physician-consortium-performance-improvement.page?.

As Allergist/Immunologists, there have been very few measures developed that apply to the diseases that we treat and those that have been developed (e.g. asthma) are very rudimentary. To address this need, subcommittees of the Joint Task Force on Quality Performance Measures of the AAAAI, ACAAI and JCAAI have begun work on developing quality measures. The hope is that these measures will contribute to improvement in the quality of care delivered by A/I specialists; and, secondarily, that these measures will be available for physician use if and when the time comes that outside entities require them.

Last year we asked you to review measures for the practice of subcutaneous immunotherapy and these were approved by the leadership of the AAAAI and ACAAI. This year, we are developing measures for Urticaria.

After years of treating patients with Urticaria, there still exists a wide discrepancy in the approach to this disease amongst allergists. The goal in developing these measures is to improve quality of care provided to patients treated for Urticaria. There are both overuse and underuse measures that have been developed based on the draft of the latest Urticaria practice parameter that is currently being developed. As implied in the description, a lower score is the goal on an “overuse” measure.

Why have these measures been developed?

After years of treating patients with Urticaria, there still exists a wide discrepancy in the approach to this disease amongst allergists. The goal in developing these measures is to improve quality of care provided to patients treated for Urticaria. There are both overuse and underuse measures that have been developed based on the draft of the latest Urticaria practice parameter that is currently being developed.

The elements of the draft measures provided for your review in this survey include the following:

a. A brief description of the measure
b. The numerator reflecting the patients meeting the measure
c. The denominator consisting of all patients eligible to be included in the measure
d. Denominator exclusions for why the measure could not be met for an individual patient
e. The supporting guideline and reference information for the measure

These measures will be disseminated to the allergy community for a 30 day review and feedback period for evaluating the appropriateness of each individual measure in a clinical setting, the practicality of completing these measures, and the necessity of these individual measures.

We would appreciate all constructive comments and criticism regarding the need and practicality of each of these measures. All comments will be dutifully reviewed by the group.

Thank you in advance for your efforts to help us develop the best measures for urticaria!

Urticaria Measures Subcommittee:

Mark Corbett MD, University of Louisville, Louisville KY- Co-chair
David Lang MD, Cleveland Clinic, Cleveland OH- Co-chair

David Bernstein MD, University of Cincinnati, Cincinnati, OH
Jonathan A. Bernstein MD, University of Cincinnati, Cincinnati, OH
Luz Fonacier MD, Winthrop University Hospital, Mineola NY
David Khan MD, UT Southwestern, Dallas TX
John Oppenheimer MD, UMDNJ-NJ medical school, Summit NJ
Steven Tilles MD, University of Washington, Seattle, WA
Steve Wasserman MD, UCSD, San Diego CA

Joint Task Force on Quality Performance Measures Co-Chairs

Michael Blaiss, MD, University of Tennessee, Memphis, TN
Michael Schatz, MD MS, Chief, Department of Allergy, Kaiser Permanente, San Diego, CA

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