Asthma Care -- Routine in My Practice

If anyone on your team routinely provides this service check the adjacent box. If it is unlikely that the service is provided routinely in your practice setting, do not check the box.

About You

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


Below you will fnd more than 30 action-items organized into four categories: (1) high quality care, (2) clinicaloperations, (3) administration and (4) school and community services.

As you read through the survey and mark each item “yes” or “no”, make a mental note of 2 or 3 “no” items thatyou might want to adopt in your setting over the next 90 days. 

You’ll have the chance in the coming months to repeat this survey to document adoption of new bestpractices. Over time most participants report adding several of these best practices to their practice routine.

Your responses are vital to our efforts to provide resources and support that meet the needs of health care teams like yours that are dedicated to improving asthma outcomes.
High Quality Medical Care
 This is a routine Activity In My Practice
1. Assess and document asthma severity at initial visit and update severity when wellcontrolled based on lowest therapy step required (intermittent, mild, moderate or severe persistent)
2. Use a step wise approach for prescribing controller therapy including EPR4 recommendations for Single Maintenance and Reliever Therapy (SMART) when appropriate.
3. Assess and document asthma control at every visit (well controlled, not wellcontrolled, or very poorly controlled), step up or step down therapy when indicated.
4. Assess, interpret and document FEV1 for all patients age 5 years and older at eachvisit (use GLI lung calculator to determine % predicted).
5. 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 by tracking FEV1% predicted over time and ensuring the FEV1/FVC ratio is near 85 or refer.
6. Assess adequacy of inhalation technique for ICS and SABA inhalers. Use samemethod for medication delivery of ICS & SABA - either MDI* or DPI for both. Documentinspiratory 􀂧ow rate and time before and after coaching. Use Aerochamber Plus® Flow-Vu® for MDIs. *preferred
7. Patients (or caregivers) complete a validated asthma control test at each visit: Testfor Respiratory and Asthma Control in Kids© [TRACK] (0-4 years) Asthma Control Test©(ACT), 4-11 version or ACT 12 & older version for youths & adults
8. For patients with persistent asthma confirm the last 3 ICS dispensing dates to determine if supply is adequate for good adherence (call pharmacy, review EMR external Rx history or claims data using CyberAccess for Medicaid patients). Note excessive SABA, systemic steroid and antibiotic dispensing patterns.
9. For uncontrolled asthma with good inhaler technique, adequate ICS supply and good adherence, complete an asthma trigger screening tool. Refer for environmental assessment & education. Document key steps to reduce triggers.
10. For uncontrolled asthma document clinical history, results and treatment of allergic rhinitis (inhalant antigen prick testing or ImmunoCAP® for inhalant antigens), gastroesophageal reflux disease, overweight, obstructive sleep apnea, vocal cord dysfunction and other co-morbidities.
11. All patients receive a written asthma action plan that documents peak 􀂧ow ranges, best FEV1 on record, an ICS step plan and other yellow zone actions to manage co-morbidities, as well as indications for a 911 call and use of albuterol 6 puffs by valved holding chamber for life-threatening asthma
12. All patients have a “key messages” dashboard to ensure delivery and documentation of critical guidance and counseling over the first 3 asthma visits and additional education thereafter.
Clinical Operations
 This is a routine Activity In My Practice
13. All families receive asthma self-care education at each encounter. High risk and impaired patients are enrolled for standardized, evidence-based asthma self-management education(AS-ME) for enhanced asthma self-care & dependent care.
14. All families are taught to check the nose and use hypertonic saline when needed (mist or rinse) to clear allergens and irritants, keeping the nose open on both sides. Nasal hygiene is taught as first step when antihistamines or nasal steroids are part of the treatment plan.
15. 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) Cancellations and “no shows” are contacted within 3 days
16. Patients 5 years and older will have peak flow and FEV1 assessed and recorded with check-in vital signs. An emergency asthma protocol is in place with albuterol, ipratropium, and epinephrine on hand for managing severe exacerbations, record FEV1. (before and after treatments)
17. All patients (or caregiver if child is less than 5 years old) identify their asthma inhalers from a poster with color photographs. “Teach back” is used to confirm the child/caregiver describe the purpose, actual use pattern and intended dosing regimen.
18. Patients 6 years and older recall how many seconds it takes to fill their lungs to deliver optimal medication dose when using inhalers. For MDIs, a valved holding chamber with inspiratory indicator is provided to enable parents, school nurses and others to coach for best technique
19. Patients >5 years use an In-Check DIAL or Aerochamber Flow-Vu to confirm they: a) gently and completely empty lungs, b) aim up to lift chin and open the airway, c) fill lungs in their target time (with IFR of 30 LPM for MDI or 60 LPM for DPI), and d) hold breath for 5-10 seconds
 This is a routine Activity In My Practice
20. Using the Respiratory Inhaler Poster for each prescribed inhaler a member of the clinical team reviews with the family: 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)need to keep MDIs at room temperature.
21. Provide printed and electronic copies of the asthma action plan with clinic contact information. Review details with patient and caregiver with ample opportunity for the family to ask questions. Use “teach back” to confirm green, yellow and red zone actions are understood. With consent, assure asthma action plans are available to school nurses, teachers, coaches, childcare workers. *
22. Review Asthma Risk Panel Reports every 6 months. Schedule uncontrolled patients into designated “asthma days” (appointment blocks) with care manager or schedule time for 99401. Authorize preventive asthma services for at risk patients (S9441, 98960, T1028, S9441-SC).􀀀
23. Child Asthma Risk Assessment Tool (CARAT) is used by clinicians, nurse care managers, asthma educators, and parents to assess and reduce risks for children with asthma along 7 domains: Medical Care, Environmental, Adherence, Responsibility, Child Well-Being, Adult Well-Being, and Asthma Attitudes.
24. High risk asthma patients, including those enrolled in Primary Care Health Home receive effective care management services (touches) based on individual assessment of need. Documented services are reviewed to align care with emerging best practices.
25. Use pre-visit alerts and EHR flags to identify and address uncontrolled asthma when patients arrive for any clinic visit, including dental and behavioral health services.
26. Maintain inventory of essential asthma supplies and ensure daily availability for clinical care (valved holding chambers with inspiratory indicators, peak flow meters, mouth pieces for digital flow meters, hypertonic saline samples, Pari nebulizer set-ups, etc.)
27. Monitor asthma CPT and supply code reimbursement. Communicate with payers to challenge rejected charges (e.g., 94664, 99401-2, 98960-1,2). Report denials that degrade asthma care to advocates - Missouri Asthma Prevention and Control Program.
School and Community Sevices
 This is a routine Activity In My Practice
28. Maintain a current directory of asthma care support resources, referral partners, insurer services and community resources to help address social determinants of health.
29. Support staff at schools and community organizations to partner in meeting needs of children with asthma. Ensure access to training and resources required to control asthma including environmental assessment and trigger abatement.
30. Reduce exposure to environmental triggers in the school, home and community by dispatching home environmental assessors to help families and staff identify & address indoor air quality problems.
31. Provide support, resources and on-demand self-management education for families and children using standardized, accessible, effective programs at home, school and in other community settings, such as faith-based and civic groups.
32. Support aligned asthma education and inhalation technique coaching through school care, home visits, pharmacy and other community services (Teaming Up for Asthma Control©, Counseling for Asthma Risk Reduction©, Acting on Behalf of My Child© and Asthma EMAT©)
33. Implement information management system for monitoring asthma control and other related co-morbid conditions that includes consented data sharing between families, clinicians and community-based providers (e.g., school nurses, community health workers, homeenvironmental assessors, asthma educators and others).
34. Advocate for school and/or district-wide policies that promote high quality asthma care, self-management education and trigger reduction. Ensure a protocol is in place for responding to life-threatening asthma exacerbations (HB 1188)