Asthma Care -- Routine in My Practice

This survey is for participants in training and education programs provided by Asthma Ready Communities, including Project ECHO.

About You

Which of these role(s) best describes you in the care of support of people with asthma? *
 

Directions

This survey lists many actions that may or may not be routine activities in your practice. The activities are organized into four categories:  (1) high quality care, (2) clinical operations, (3) administration and (4) community services.

Your responses are vital to our efforts to provide high quality training that is responsive to the needs of health care teams dedicated to high quality asthma care.

High Quality Medical Care
 This is routine activity at my practice.
Q1. Assess Severity Initial Visit. Assess and document asthma severity at initial visit and update severity when well controlled based on lowest therapy step required (intermittent or mild, moderate or severe persistent)
Q2. Assess Asthma Control Always. Assess and document asthma control at every visit (well controlled, not well controlled, or very poorly controlled)
Q3. FEV1. Assess, interpret and document FEV1 for all patients age 5 and older at each visit
Q4. Spirometry. Order and evaluate spirometry every 1-2 years for all patients 6 years and older (FVC, FEV1, and FEF25-75), determine lung growth pattern and evidence for lung function impairment
Q5. Inhalation Technique. Assess adequacy of inhalation technique for ICS and LABA inhalers (MDI and DPI, if using). Document inspiratory flow rate and time before and after coaching.
Q6. Use Validated Asthma Control Test. Patients (or caregivers) complete a validated asthma control test at each visit: TRACK (0-4 years), ACT (4-11 version) for 5-11 or ACT (12 years and older version)
Q7. Confirm Medication Adherence. For patients with uncontrolled asthma the last 3 ICS dispensing dates will be confirmed to determine if adherence is supported (call patients pharmacy or review claims data reports)
Q8. Home Environment Assessment Referral. For uncontrolled asthma with good inhaler technique and adherence complete an asthma trigger screening tool and consider referral for home environmental assessment & education
Q9. Evaluate Co-morbidities. For uncontrolled asthma with good inhaler technique and adherence evaluate and document clinical history/results for allergic rhinitis (inhalant antigen prick testing or Immunocaps for perennial antigens), sinusitis, gastroesophageal reflux, and other co-morbidities
Q10. Written Asthma Action Plans. All patients receive a written asthma action plan that documents peak flow ranges, best FEV1 on record, an ICS step plan and an order for albuterol 6 puffs by valve holding chamber for life-threatening asthma
Q11. Key Message Prompts in EHR. All patients will have a “key messages” EHR dashboard to ensure delivery of critical guidance and counseling over the first 3 asthma visits
Q12. Self-management Education. High risk and impaired patients will be enrolled for standardized, evidence based education for asthma self-care (or dependent care)
Clinical Operations
 This is routine activity at my practice.
C1. Timely Follow-up Visits. Ensure that follow-up visits are set at appropriate intervals matching level of control (1-2 weeks for very poorly controlled, 2-6 weeks for not well controlled and 1-6 months for well controlled)
C2. Vital Signs. Patients 5 years and older will have peak flow and FEV1 assessed and recorded with check-in vital signs
C3. Color Photographs of Medications. All patients (or caregiver if child is less than 5 years old) identify their asthma inhalers from a poster with color photographs, describe medicine purpose and frequency of use.
C4. Lung Fill Time. Patients 6 years and older recall how many seconds it takes to fill their lungs with their ICS inhaler medication.
C5. Inhalation Technique. Patients 6 years and older use an In-Check DIAL to demonstrate how they a) gently and completely empty their lungs, b) lift their chin to open the airway, c) fill their lungs in their target time (with IFR of 25-35 LPM for MDI), and d) hold their breath for 5-10 seconds
C6. Inhaled Medication Education. Using the Respiratory Inhaler Poster for each of the patients inhalers a member of the clinical team reviews with each patient: a) whether or not to shake before use, b) priming steps, c) how many days (or months) the inhaler is expected to last, d) cleaning and care of the inhaler, e) keep at room temperature
C7. Written Asthma Action Plans. Provide printed copies of the asthma action plan with clinic contact information; provide detailed review with patient and ample opportunity for the family to ask questions.
Administration
 This is routine activity at my practice.
A1. Asthma Panel Reports (APR) & Block Scheduling. Review APR quarterly. Schedule uncontrolled asthma patients into a regular time slot and day of the week/month with 99401-2. Obtain orders for preventive asthma services for at risk patients (S9441, T1028, 98960).
A2. Monitor Billing Codes. Monitor asthma billing codes and communicate with payers to clarify reasons for rejected charges.
A3. Pre-Visit Alerts & Appointment No-Shows. Ensure use of pre-visit alerts to address uncontrolled asthma. Contact and reschedule patients who do not show for appointments.
A4. Supplies. Identify inventory of needed asthma supplies and ensure daily availability for care providers.
Community Sevices
 This is routine activity at my practice.
S2. Training Staff. Train staff at schools and community organizations to identify needs of children with asthma
S3. Prepare Others for Emergency Care. Prepare school personnel or community members to provide emergency care at school or events (e.g., sports, field trips)
S4. Current Asthma Action Plans. Assure asthma action plans are current, relevant and shared with teachers, coaches and other personnel
S5. Trigger Reduction. Reduce exposure to environmental triggers in the school and/or at home
S6. Supportive Care Education for Families. Provide supportive and self-management care education for families or children with standardized materials/programs at home or in other community setting
S7. Inhalation Technique. Provide education on inhalation technique during home visit or in other community settings
S8. Linking Care. Report health status of children with asthma to schools and/or other community-based organizations who take care of the child
S9. Assess Medication Adherence. Receive information about medication adherence regularly from community-based partners and incorporate data into outreach activities or treatment parents
S10. Directory of Resources. Maintain updated directory of asthma care support resources, referral partners and insurance coverage
S11. Tracking System. Implement information management system for tracking people with asthma and other chronic conditions that includes access for community-based providers (e.g., school nurses)
S12. School Policy. Advocate for school and/or district-wide policies that promote high quality asthma care, self-management or trigger reduction.