As protectors of the public's health, State governments play a vital role in preventing asthma and controlling its consequences. Most States have some public resources invested in asthma prevention, monitoring, and care programs, although the level of investment may vary from State to State. As health care purchasers, States are responsible for ensuring that the health care they pay for on behalf of State employees, Medicaid clients, and other recipients meet standards of quality. There are a number of reasons why States may want to take a closer look at improving quality of care for asthma, including: The increased prevalence of asthma, especially among children and adolescents; The disparities between various racial and ethnic groups in diagnosis and quality of asthma care; Interventions and treatment that can successfully control the disease and prevent attacks; The high health care cost of uncontrolled asthma and the potential for return on investment for purchasers, including State Medicaid agencies, through asthma quality improvement. The aim of this Workbook is to help State leaders develop information to support health care quality improvement. Its written exercises should help State leaders begin to think about an effective partnership for an initiative, assembly of available data for their State, questions to raise about interpretation of the data, and quality improvement techniques. It also should help readers apply information and concepts from the Resource Guide to their own States. Upon completion of the Workbook, State leaders will be able to: Understand the key factors that determine whether there is a need for an asthma care quality improvement in their State (i.e., "make the case"); Identify partners to plan, develop, and support a quality improvement strategy for asthma; Identify national, public-private, Federal, State, and local resources and activities related to asthma quality improvement; Identify appropriate asthma data sources and measures and develop estimates from data for assessing the State's performance in providing asthma care; Identify opportunities to contribute to improving asthma care quality. This Workbook is a start for State leaders interested in learning about quality improvement for asthma care. The actual planning, implementation, tracking, and evaluation of an asthma care quality improvement program will go well beyond this Workbook and its companion Resource Guide. Carrying out such a program will require a team of experts: State leaders and agency staff, program staff, topic experts, researchers, health specialists, statisticians, data collection experts, evaluation researchers, and representatives from stakeholder groups