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About half of our readers say they are seeing too many chronic urticaria patients.

  Study to follow people exposed to WTC ash, dust
New York City and federal health officials are firming up details of a $20 million project paid for by federal disaster relief money that will track the health of as many as 200,000 people exposed to ash and dust from the World Trade Center’s collapse. Scientists plan to evaluate whether exposure caused any long-term pulmonary effects. 

  ACAAI’s Allergy Watch Online is a comprehensive review of 17 major medical journals. The following articles are from the November-December 2002 issue:

• Body mass index linked to methacholine AHR in older men
• Tetracycline drugs suppress IgE production by asthmatic PBMCs
• Family supports genetic background of chronic idiopathic urticaria
• IL-4R gene polymorphism interacts with infection, study suggests
• Trial confirms effectiveness of SIT for asthmatic children

See the entire issue online: Click here.

  Physicians Consortium for Performance Improvement sets standards for medical care

By Jean A. Chapman, M.D., ACAAI Representative to Physicians’ Consortium and Co-Chair Asthma Work Group

The Centers for Medicare and Medicaid Services (CMS) – the largest purchaser of medical care in America – has asked the Physicians Consortium for Performance Improvement for help. This is a great opportunity for the physicians in dealing with the federal government to lead in the improvement of the quality of medical care in this country.

In response to this request by CMS, the AMA has agreed—on behalf of the AMA-convened Physician Consortium for Performance Improvement (The Consortium)—to provide to CMS evidence-based performance measures and reporting tools developed by the Consortium for use in the Doctor’s Office Quality (DOQ) Project. The performance measures are intended for use in demonstration projects/pilot tests in Quality Improvement Organizations (QIOs) in California, New York, and Iowa.

The primary goal of the DOQ Project, which is focused on care in the outpatient setting, is to measure the quality of chronic disease care and prevention at the level of the individual practitioner and/or group for the purpose of quality improvement.

The Working Group for the Core Physician Performance Measurement Set for Asthma developed measures for Asthma Assessment and Pharmacologic Therapy and is now evaluating response forms submitted during The Consortium and public comment periods completed in December 2002.

  The AMA urges the Practicing Physicians Advisory Council (PPAC) to recommend that CMS, as it proceeds with the DOQ Project:

• Use the Consortium’s evidence-based performance measures and any resulting data for quality improvement purposes only, the purpose for which the measures are designed and intended;
• Continue to work with the AMA and The Consortium to ensure the appropriate development and implementation of evidence-based clinical performance measures that enhance the quality of patient care and advance the science of clinical performance measurement and improvement;
• Use information gleaned from implementing the measures in the pilot tests of the DOQ Project to further refine the measures, if necessary, in collaboration with The Consortium, and The Consortium should be involved in future implementation efforts;
• Recognize the "state-of-the-art" of physician performance measurement, which supports the use of measurement to promote continuous quality improvement; existing methodologies do not warrant the use of these measures for purposes of individual accountability, comparison, or choice;
• Acknowledge the serious limitations in using performance measurement to assess physician competence and to work with the AMA and The Consortium to ensure that data from the DOQ Project are used to improve the overall quality of patient care and not to assess individual physician performance;
• Consider the burden of data collection; consider the use of electronic medical systems to collect and process data; and agree to collect data for the DOQ Project prospectively only;
• Involve the national medical specialty societies and boards in addressing what constitutes the appropriate specialty-specific variance in clinical practice; and
• Indicate physician participation only as the sole criterion for public recognition by the DOQ Project.

The Consortium’s evidence-based performance measures and any resulting data are designed and intended for quality improvement purposes only. Information on the AMA’s clinical quality improvement initiatives, including The Consortium’s performance measurement sets, is available online at www.ama-assn.org/go/quality.