• LamSean Shao WeiSSWDuke-NUS Medical School, National University of Singapore, Singapore.Health Services and Systems Research, Duke-NUS Medical School, Singapore.Health Services Research Centre, Singapore Health Services, Singapore.Health Services Research, Jingwei Chen, Jun Tian Wu, Chun Fan Lee, Narayanan Ragavendran, OngMarcus Eng HockMEHDuke-NUS Medical School, National University of Singapore, Singapore.Health Services and Systems Research, Duke-NUS Medical School, Singapore.Health Services Research Centre, Singapore Health Services, Singapore.Health Services Resear, Ngiap Chuan Tan, Chian Min Loo, David Bruce Matchar, and Mariko Siyue Koh.
• Duke-NUS Medical School, National University of Singapore, Singapore.
• Ann Acad Med Singap. 2023 Oct 30; 52 (10): 497509497-509.

IntroductionAsthma guidelines have advocated for the use of quality-of-care indicators (QCIs) in asthma management. To improve asthma care, it is important to identify effective QCIs that are actionable. This study aimed to evaluate the effect of the presence of 3 QCIs: asthma education, Asthma Control Test (ACT) and spirometry testing on the time to severe exacerbation (TTSE).MethodData collected from the SingHealth COPD and Asthma Data Mart (SCDM), including asthma patients managed in 9 SingHealth polyclinics and Singapore General Hospital from January 2015 to December 2020, were analysed. Patients receiving Global Initiative for Asthma (GINA) Steps 3-5 treatment, with at least 1 QCI recorded, and at least 1 severe exacerbation within 1 year before the first QCI record, were included. Data were analysed using multivariate Cox regression and quasi-Poisson regression models.ResultsA total of 3849 patients in the registry fulfilled the criteria. Patients with records of asthma education or ACT assessment have a lower adjusted hazard ratio (HR) for TTSE (adjusted HR=0.88, P=0.023; adjusted HR=0.83, P<0.001). Adjusted HR associated with spirometry is higher (adjusted HR=1.22, P=0.026). No QCI was significantly associated with emergency department (ED)/inpatient visits. Only asthma education and ACT showed a decrease in the number of exacerbations for multivariate analysis (asthma education estimate: -0.181, P<0.001; ACT estimate: -0.169, P<0.001). No QCI was significant for the number of exacerbations associated with ED/inpatient visits.ConclusionOur study suggests that the perfor-mance of asthma education and ACT was associated with increased TTSE and decreased number of exacerbations, underscoring the importance of ensuring quality care in clinical practice.

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