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Chronic obstructive pulmonary disease National Action Plan Tracking System - Preliminary Model (Private Sector)

OMB: 0925-0766

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Exp. 4/30/2023



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COPD National Action Plan Collaboration and Tracking System Preliminary Model

Shape1


Welcome!


Please share your activity or initiative in support of the National Action Plan. Report only one activity per form submission.



  1. Shape2
    Name of the activity


  1. Primary contact for this activity


Shape3 Name


Shape4 Organization

(for this activity)

Shape5 Role in organization


Shape6 City/Town


Shape7 State/Province


Shape8 Email Address


Shape9 Phone Number


  1. Which best describes you or your organization?

Advocacy organization/non-profit Health professional organization Health care provider

Industry

Federal, state, or local government agency Academic institution

Policymaker

Other (please describe)

Shape10



Shape11


Briefly describe your activity and how it contributes to the goals and objectives of the COPD National Action Plan.



  1. Shape12
    Summary (max 1500 characters)


  1. Shape13
    Include any links where people can learn more (websites, social media, journal articles, etc.).



  1. Which goal of the National Action Plan does this activity best align with? While an organization might address multiple goals, each individual activity usually focuses most strongly on one. If this activity has a strong focus on more than one goal, please choose a primary and up to two secondary goals.


Primary


Secondary

1: Empower people with COPD, their families, and caregivers to recognize and reduce the burden of COPD.




2: Improve the prevention, diagnosis, treatment, and management of COPD by improving the quality of care delivered across the health care continuum.




3: Collect, analyze, report, and disseminate COPD-related public health data that drive change and track progress.




4: Increase and sustain research to better understand the prevention, pathogenesis, diagnosis, treatment, and management of COPD.




5: Translate national policy, educational, and program recommendations into research and public health care actions.






Shape14

Items 7-11 list objectives of each goal. Please select only objectives corresponding to the goal(s) you selected above, then continue on page 5.



  1. Goal 1: Empower people with COPD, their families, and caregivers to recognize and reduce the burden of COPD.

If you chose this goal and your activity addressed specific objectives, please select all that apply.


Shape15 Increase public awareness of the risk factors and symptoms of COPD so that earlier diagnosis of symptomatic individuals becomes the norm


Shape16 Increase the effectiveness and variety of outreach communication campaigns and activities that utilize evidence-based approaches to raise awareness of COPD, particularly among those at high risk, and help people diagnosed with COPD manage the disease


Shape17 Expand opportunities to increase COPD awareness across the public-private spectrum




  1. Goal 2: Improve the prevention, diagnosis, treatment, and management of COPD by improving the quality of care delivered across the health care continuum.


If you chose this goal and your activity addressed specific objectives, please select all that apply.


Shape18 Develop, disseminate, and maintain unified, multidisciplinary, and patient-centric national guidelines for COPD that are accessible and easy to follow


Shape19 Develop a unified, multidisciplinary educational curriculum for health care professionals, including primary health care providers, using harmonized clinical practice guidelines


Shape20 Develop, in accordance with clinical quality measures, a clinical decision tree and other tools to enable high-quality care for people with COPD


Shape21 Develop and encourage the use of a written, patient-centric COPD management plan tool, with appropriate cultural and health literacy considerations, which can be customized with input from the patient's health care provider(s)


Shape22 Improve access to care for people with COPD, particularly for those in hard-to reach areas


  1. Goal 3: Collect, analyze, report, and disseminate COPD-related public health data that drive change and track progress.


If you chose this goal and your activity addressed specific objectives, please select all that apply.


Shape23 Enhance and optimize our capacity to collect and aggregate data from multiple sources, including at local, regional, and national levels, and turn them into actionable information.


Shape24 Facilitate dissemination of data and analyses. Report the prevalence of COPD in accordance with the requirements of public health and health care organizations



  1. Goal 4: Increase and sustain research to better understand the prevention, pathogenesis, diagnosis, treatment, and management of COPD.


If you chose this goal and your activity addressed specific objectives, please select all that apply.


Shape25 Help expand, coordinate, and optimize COPD research efforts


Shape26 Improve methods for earliest detection and diagnosis and develop effective strategies for preventing the onset and progression of COPD


Shape27 Define and characterize the pathogenesis of COPD heterogeneity


Shape28 Develop personalized medicine for COPD based on the pathogenesis and clinical heterogeneity


Shape29 Promote research that can lead to strategies that help prevent the onset and progression of COPD and improve the quality of COPD care and management





  1. Goal 5: Translate national policy, educational, and program recommendations into research and public health care actions.


If you chose this goal and your activity addressed specific objectives, please select all that apply.


Shape30 Put into action prevention strategies that are proven effective in addressing the 80 percent of COPD deaths due to smoking


Shape31 Create a collaborative official entity that implements, prioritizes, and tracks activities in accordance with the COPD National Action Plan's goals and objectives


Shape32 Shape33 Shape34 Identify and publicize funding opportunities that advance the implementation of the COPD National Action Plan Develop and implement COPD quality measures into national care delivery

Strengthen the public health infrastructure for addressing COPD



  1. Shape35 Shape36 Which audience(s) did your activity serve? Choose all that apply.


Shape39 Patients


Shape40 Caregivers, family members


Shape41 Shape42 Shape43 At-risk populations (history of smoking, workplace exposure to lung irritants, alpha-1 antitrypsin deficiency)


Shape44 General public


Shape45 Other (please describe)

Shape46

Health professionals Employers Researchers Policymakers




  1. Did your activity focus on any of the following groups? Choose all that apply.


Hispanic

Men

Non-Hispanic American Indian or Alaska Native

Women

Non-Hispanic Asian or Pacific Islander



Non-Hispanic Black



Non-Hispanic White


Other (please describe below)




















  1. Shape47 Which best describes your activity? Choose all that apply.


Shape48 Shape49 Shape50 Patient education

Event

Shape51 Shape52 Shape53 Shape54 Shape55 Shape56 Campaign

Healthcare delivery

Material or product (indicate type — print, audio, visual, etc. — under other)

Provider education

Shape57 Research Service Support group Training

Other (please describe)

Shape58



Timing of your activity


  1. Shape59
    When did it start? (Month and year)


  1. When did it stop, or is it ongoing?

Ongoing

Stop date (Month and year)

Shape60


What area(s) of the country does your activity cover?



  1. Geographic location (Choose all that apply) 18. Type of area (Choose all that apply)


National

Urban

Regional (multi-state; indicate states: _________________________________)

Suburban

State (indicate state: ________________)

Rural

Local (indicate state: ________________)



Other (please describe below)













  1. Setting in which your activity is implemented (choose all that apply)

Community Health care Home

Workplace Online

Other (please specify)

Shape61


  1. If this activity was a collaborative effort, please list the other entities involved.


Shape62 We worked alone


Shape63 We worked with the following organization(s) or individual(s)

Shape64


  1. Please describe how much this activity cost and its funding sources.

Shape65

  1. What impact has your activity had so far? (Include quantitative data if available, such as analytics, number of attendees or enrollees, quantities distributed or downloaded, etc.)

Shape66


  1. Shape67
    What advice or lessons learned do you have for anyone considering a similar activity?

  2. Shape68
    What role did the COPD National Action Plan play in helping you develop the activity (e.g., provide ideas, lead to new collaborations or funding, etc.)?



  1. Would you be interested in highlighting this activity more broadly with other COPD stakeholders?

Yes No






Thank you for contributing to the COPD National Action Plan Collaboration and Tracking System.

Shape37 Shape38

9

Draft — February 6, 2020


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleView Survey
AuthorAmmary-Risch, Neyal (NIH/NHLBI) [E]
File Modified0000-00-00
File Created2021-01-14

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