Tools
In order to develop a high-quality asthma care delivery system, a practice must have all of the nine system components for excellent asthma care elements in place. These evidence-based changes are based on the NHLBI National Asthma Education and Prevention Program (NAEPP) and the Chronic Illness Model by Ed Wagner. Italicized changes indicate measures tracked in Community Care of North Carolina Asthma Disease Management program audits.
Accurate Classification of Severity
This easy-to-read decision support tool helps determine asthma severity based on symptoms, frequency and lung function, plus recommended therapies.
Asthma Severity / Medications (part 1) (98k)
Asthma Severity / Medications (part 2) (90k)
Part 2 includes medication details. It also includes recommendations for children 5 years of age and under. Many practices laminate these two sheets into one reversible card that is placed in each exam room and at workstations for quick reference. This tool has been updated by Community Care of North Carolina.
Asthma Stepwise Approach (188k)
This easy-to-read decision support tool helps determine asthma severity based on symptoms, frequency and lung function, plus recommended asthma management plan details. The severity scheme is the same as the Asthma Severity / Medications tool described above. It also provides a structured encounter form, which includes quality-of-life measures and suggested therapy.
Planned Care
Asthma Visit Form with Patient Questions (112k)
The Planned Care structured encounter form provides prompts and includes questions for determining severity and quality of life. Parents / patients complete the upper half of the tool. This tool was developed by one of the Community Care of North Carolina networks.
Asthma Visit Form (111k)
This tool is for a planned asthma visit. The structured encounter form includes a completion table for lung function values. This encounter form also serves as a data entry tool for quality measures and a planned visit organizer. Some practices have printed this on colored paper or established a section in their chart to file this form in order to track progress over time.
Asthma Management Plans
These are asthma management plans to be completed by the provider with the necessary information for the individual child. The information in the plan should be explained to the patient / parent by the provider. The patient / parent should be given copies of their plan to take home, to give to the school, and to give to childcare providers.
There are many good asthma management plans (or action) plans available. We have included four examples. Standard plan in English and Spanish and a second plan for families with more visual aids and less emphasis on peak flow results. Many practices have found that printing these on color NCR forms (a form in triplicate) helpful to provide copies for home and school easily, especially when initiating this change in their office system.
English Asthma Management Plan (87k)
Spanish Asthma Management Plan (329k)
Self-Management Support and Trigger Identification
1on1health is a collaborative effort between physicians and other healthcare professionals, patients and GlaxoSmithKline. The content in the 1on1health program was developed in association with WebMD. The section on asthma, Asthma1on1, includes a variety of tools and activities for all audiences - articles, videos, games, quizzes, role-playing, reminders, activities and animations. This variety of items was assembled to help both patients and caregivers maximize their learning potential.
Turning Patient Education into Self-Management Support (26k)
This document describes an approach to patient education and behavior change that is based on the creation of a partnership between the provider and the patient. With self-management support, the provider actually engages the patient and family in goal setting for behavior changes related to their chronic illness to actively involve the patient in the management of his / her disease.
Smoking Cessation Pocket Card (143k)
This is a quick guide to pharmacotherapy and tobacco treatment that can be printed on a pocket-sized, two-sided laminated card small enough for physicians to keep in their pockets. On one side of the card is a list of nicotine replacement options and non-nicotine medication. On the other side, the 5A tobacco intervention activities are described. The questions on this laminated card are based on the American Cancer Society 5A Counseling model for smoking cessation counseling.
Patient Checklist for Environmental Triggers (143k)
This handout for patients and families is in checklist format to help families assess their home environment for environmental triggers. It is from the Practical Guide for the Diagnosis and Management of Asthma from the National Heart, Lung, and Blood Institute. Download the entire guide, free of charge, from the and can be downloaded from the National Heart, Lung, and Blood Institute web site.
KidsHealth is the largest and most visited site on the web, providing doctor-approved health information about children from before birth through adolescence.
Created by The Nemours Foundation's Center for Children's Health Media, the award-winning KidsHealth provides families with accurate, up-to-date and jargon-free health information they can use. KidsHealth has separate areas for kids, teens and parents -- each with its own design, age-appropriate content and tone. There are literally thousands of in-depth features, articles, animations, games and resources -- all original and all developed by experts in the health of children and teens.
Resources
- Accelerating Change Today for America's Health (ACT)
Curing the System: Stories of Change in Chronic Illness Care (May 2002, 40 pages)
This publication highlights the work of the National Coalition on Health Care and the Institute for Healthcare Improvement (IHI). Under the leadership of Ed Wagner and Connie Davis, profiles of individuals, institutions, and organizations that have demonstrated excellence in chronic disease care are presented in this document. It describes the face of chronic disease care and how various health settings have used the Improving Chronic Illness Model to assist them in redesigning their systems. The typical physician 15-minute visit that is initiated by patients doesn't necessarily lend itself to chronic disease management. Find out more about the chronic illness model by reviewing this excellent publication. It has stories, not only for asthma care, but for other conditions, such as diabetes and congestive heart failure. Go to page 15 to read about Hill Health Center's work in their pediatric asthma program. - National Coalition on Health Care
- Institute for Healthcare Improvement
- Achieving Better Care for Asthma -- Toolkit
Center for Health Care Strategies - A Best Clinical and Administrative Practices (BCAP) Toolkit for Medicaid Health Plans (November 2002, 82 pages)
This publication is written for medical directors of state health plans, but the content is easily applicable for a medical director of any group of practices. CHCS uses a four part system to achieve better care: Identification, Stratification, Outreach, and Intervention. The Model for Improvement (page 7) is described, examples of asthma registries are given (page 14), and use of administrative data for classifying asthma severity is explained (page 24). There is a section for provider-level change, including a case study (page 56), office strategies with multiple appendices of examples. Page 78 lists recommended readings. - Center for Health Care Strategies
- Asthma eQIPP module
This module is appropriate for the general pediatrician. The module features online seminars and activities centered on asthma epidemiology and pathogenesis, diagnosis and severity classification, medications, management and follow-up plans. You will complete a combination of online and offline activities. The module activities are scheduled over a 9-12 month period. You have access to the eQIPP Asthma Module for 3 years. You can claim CME credit for each unit that you complete. If you complete the whole module, that translates into 20 AMA PRA Category 1 credits. - Asthma Control Test
Developed by QualityMetric Incorporated, and supported by the American Lung Association and GlaxoSmithKline, this Childhood Asthma Control Test is designed for children between 4 and 11 years old. No matter how well controlled you think your asthma is, everyone in this age group should take the test. The score based on your answers to the 5-question quiz will help you and your doctor determine if your child's treatment plan is working or if it might be time for a change. - CCNC Asthma disease management
- Creating a Medical Home for Asthma – An Asthma Management Program for Healthcare Providers
Creating a Medical Home for Asthma (CMHA) is an asthma management program developed under the leadership of Dr. David Evans by a team of pediatricians, asthma specialists, a health educator, and an educational psychologist. CMHA was designed to improve pediatric asthma care within public health clinics. It promotes a team-based approach to asthma management, and includes strategies to improve communication. - Healthcare Improvement Skills Center
This series of six modules provides assistance to practitioners working to improve medical practice. The site offers valuable skills, methods, processes, and techniques that have aided other healthcare professionals. The modules walk you through the steps of developing a quality improvement project and offers tools to carry it out. Module 4 teaches you the basic quality improvement tools and skills needed to identify sources of unwanted variation in a process and to evaluate interventions.
Articles
- Bradley EH, Webster TR, Baker D, Scheslinger M, Inouye SK, Barth MC, Lapane KL, Lipson D, Stone R, Koren MJ (July 2004): Diffusion of innovation: Translating research into practice: Spreading the adoption of innovative health care programs. The Commonwealth Fund. Issue Brief #724.
- Paula Lozano, MD, MPH; Jonathan A. Finkelstein, MD, MPH; Vincent J. Carey, PhD; Edward H. Wagner, MD, MPH; Thomas S. Inui, MD; Anne L. Fuhlbrigge, MD, MS; Stephen B. Soumerai, ScD; Sean D. Sullivan, PhD; Scott T. Weiss, MD; Kevin B. Weiss, MD: A Multisite Randomized Trial of the Effects of Physician Education and Organizational Change in Chronic-Asthma Care. Arch Pediatr Adolesc Med. 2004;158:875-883
- Morgan W, et al. (2004) Results of a Home-Based Environmental Intervention among Urban Children with Asthma. The New England Journal of Medicine, Volume 351:1068-1080.
- Bodenheimer T, Wagner EH, & Grumbach K. (2002). Improving primary care for patients with chronic illness. Journal of the American Medical Association, 288 (15), 1909-1914.
Links
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