Healthcare is quickly shifting from volume based care to value based care where providing better patient satisfaction, better patient outcomes and reduced cost comprise the “triple aim” goals of managing chronic disease populations to include asthma population health. From an asthma population health perspective greater adherence to guideline based care provides opportunity to deliver more standardized care from the health system perspective while personalizing the diagnosis and management for the patient. A majority of patients, both pediatric and adult, with a diagnosis of Asthma are atopic and the majority of these asthma patients are managed by a primary care provider. A majority of payers, health systems and asthma coalitions recommend environmental control as key strategy in optimally managing and controlling Asthma.
These recommendations are based on Evidence Category A data assessed by the Expert Panel Report 3 (EPR–3) 2007: Guidelines for the Diagnosis and Management of Asthma published by the NHLBI of the NIH.The EPR-3 Guidelines also recommend (Evidence Category A) the use of in vitro (blood) or in vivo (skin) testing to assess patients for their sensitizations as a means to evaluate results against patient history and optimally focus the development and implementation of effective exposure reduction strategies.The use of specific IgE testing improves the accuracy of an assessment of a patient’s sensitizations when compared to patient opinion or structured history alone.
Numerous studies have demonstrated that adherence to guidelines-based asthma care can significantly reduce asthma related hospitalizations and ED visits.Numerous other studies also demonstrate that through individualized self-management (testing and avoidance counseling can play a big role) significant decreases in medications can be achieved along with improvement in quality of life (less missed school/work). Despite guideline recommendations, and the availability of specific IgE testing from a majority of laboratories, these benefits are not being realized within asthma population health. Despite guideline recommendations most asthmatics have never been tested. There is a clear opportunity, achieved through greater adherence to guidelines based care, to improve patient satisfaction and population health while reducing the per capita costs of managing asthma.
The omission of testing and subsequent environmental control education (Evidence Category A) represents a gap in asthma care. Inclusion of testing as part of standard of care in the diagnosis and management of Asthma promotes standardization of care from the provider/health system perspective and personalization of care from the patient perspective driving better care, better outcomes and reduce costs. Interpretation of results and alignment to effective exposure reduction strategies are critical components.