Severe asthma care and treatment: indicators and data for performance management across ten countries

OBJECTIVES: This paper outlines the rationale and need for a conceptual framework comprising a standard set of necessary indicators to assess performance in severe asthma (SA) care and practice, together with an analysis of the current availability of statistical data on this topic across ten countries in order to understand the quality of evidence on performance in SA care and practice. METHODS: An expert panel contributed to the creation of the framework and performance indicators, based on what is relevant and clinically meaningful for SA as an indication; the framework consists of four components: diagnosis of SA, treatment of SA, care provision for SA, and the socio-economic impact of SA. Study countries included were Australia, Brazil, Canada, France, Germany, Italy, Japan, Spain, Sweden, and the United Kingdom, all representing different approaches to health care financing, organisation and delivery, and geographic regions. Publicly available data from national and international sources was reviewed against the framework along with research to identify statistical sources and assess the availability of data on SA in each study country. RESULTS: SA is a complex diagnosis and condition, and performance indicators need to be designed to reflect SA care and practice holistically and accurately. 44 indicators were identified across six themes: prevalence, policy structures and organisation, diagnosis, treatment, care delivery, and socio-economic impact. Clear gaps in the statistical evidence for performance in SA care exist across the study countries, as little public national or international data was identified for these indicators. Where available, data is limited to general data on healthcare resource use and drug reimbursement and often exists only for asthma diagnoses, not SA in particular. CONCLUSION: SA remains an area of significant unmet need. There is clear imperative to improve data collection and reporting across all dimensions of SA care to ensure appropriate interventions are designed and implemented to reduce avoidable morbidity and mortality and improve quality of care. Both clinician and patient perspectives should be recognised when considering country-level performance in SA care and practice.