0920-0853 PM Reporting Tool MAY2023

[NCEH] Asthma Information Reporting System (AIRS)

Att5a_PMReportingTool.xlsx

OMB: 0920-0853

Document [xlsx]
Download: xlsx | pdf

Overview

Analysis and Use of Core (PMA)
Comprehensive Service (PMC)
Changes in Population (PM H)
Use of Eval Findings (PME)
Linking Activities (PMB)
Quality of Guideline (PMD)
AS-ME and Improvement (PMFG)


Sheet 1: Analysis and Use of Core (PMA)


PM A: PM A: Analysis and Use of Core Data Sets
Number and percentage of core measures updated, analyzed and disseminated/used during the reporting period.














Required Field

Required Field Required Field

Core Data Sets Was this dataset analyzed during this reporting period? Most recent year of data analyzed (drop-down for Year: Corresponding Core Measures Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover-over instructions: "Reported" is defined as this estimate appearing in an externally facing document, or posted on the Internet. Was this measure updated and reported during the reporting period? Most Recent Result Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover-over instructions: If multiple years of data were combined for the child ACBS, for example, please select all years that were combined to obtain this result. Year(s) of most recent result
Select all that apply.

Response type These are label Drop down This is a drop down These are label Drop down Data field Checkbox
Response options (if applicable) n/a Y/N 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017, 2016, 2015, 2014, 2013) n/a Options are either
Y/N
or
Y/N/Insufficient sample size
% should not exceed 100% or be less than 0%
For figures /10,000 or 1,000,000, number should not exceed the denominator also no negative numbers
2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017, 2016, 2015, 2014, 2013)

Hospital Discharge Y/N
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover-over instructions: Include when asthma is the 1st-listed discharge diagnosis Hospital Discharge Rate Y/N /10,000 pop


Emergency Department Visits Y/N
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover-over instructions: Include when asthma is the 1st-listed discharge diagnosis Emergency Department Visits Rate Y/N /10,000 pop


Mortality Y/N
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover over instructions: Include when Asthma is listed as the underlying cause of death Mortality Rate Y/N /1,000,000 pop


BRFSS Core Y/N
Adult Lifetime Asthma Prevalence Y/N %



Y/N
Adult Current Asthma Prevalence Y/N %


BRFSS Child Prevalence Module Y/N
Child Lifetime Asthma Prevalence Y/N %





Child Current Asthma Prevalence Y/N %


Asthma Call-Back Survey- Adult Y/N
Adult




Asthma Control Y/N %



Asthma Attacks (in the past 3 months) Y/N %



Asthma Attacks (in the past 12 months) Y/N %



Activity Limitations Y/N %



Missed Work Days Y/N %



Self-management Education


Taught to recognize signs/symptoms Y/N %



Taught what to do during an asthma attack Y/N %



Taught to use a peak flow meter Y/N %



Ever been given an asthma action plan Y/N %



Ever taken an asthma management Course Y/N %


Asthma Call-Back Survey - Child Y/N
Child




Asthma Control Y/N/Insufficient Sample Size %



Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Deloitte, these two highlighted fields were changed from 30 days to 3 months Asthma Attacks (in the past 3 month) Y/N/Insufficient Sample Size %



Asthma Attacks (in the past 12 months) Y/N/Insufficient Sample Size %



Activity Limitations Y/N/Insufficient Sample Size %



Missed School Days Y/N/Insufficient Sample Size %



Self-management Education


Taught to recognize signs/symptoms Y/N/Insufficient Sample Size %



Taught what to do during an asthma attack Y/N/Insufficient Sample Size %



Taught to use a peak flow meter Y/N/Insufficient Sample Size %



Ever been given an asthma action plan Y/N/Insufficient Sample Size %



Ever taken an asthma management course Y/N/Insufficient Sample Size %



Sheet 2: Comprehensive Service (PMC)

PM C: Comprehensive Service Expansion in High Burden Areas
Number and description of existing, new, and discontinued services supported by recipient and partners, by geographic area and intervention type; and alignment of services with high burden geographic areas.

Response type Response options (if applicable)
Title of Intervention
required field
Drop-down or radio button Breathe Well, Live Well
Kickin' Ashthma
Open Airways For Schools
You Can Control Asthma
Wee Breathers
Wee Wheezers
Other [ describe]
Title of Intervention Other
optional field
Open Text Open Text
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: Select the EXHALE strategy to which this intervention best corresponds. If none, select other, and describe. EXHALE Intervention Type
required
Drop-down or radio button o Education on asthma self-management (AS-ME)
o eXtinguish smoking and secondhand smoke
o Home visits for trigger reduction and asthma self-management education
o Achievement of guidelines-based medical management
o Linkages and coordination of care across settings
o Environmental policies or best practices to reduce asthma triggers from indoor, outdoor, and occupational sources
Intervention Status
optional
Drop-down or radio button o Intervention is active at the same level as last period
o Intervention has been expanded since last reporting period to more areas or to reach more people
o This is a new activity
Implementation status Drop-down or radio button Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover-over instructions. Choose the option that best fits the status of implemation of this policy or program. 1. Exploration and Community Assessment Identify needs and potential evidence-based solutions to meet the needs, as well as soliciting support (vision, funding, etc.) for the changes. 2. Develop implementation plan and build capacity Select initial sites and develop written implementation plan; build system capacity to support the implementation of new policies/practices at selected sites. 3. Initial Implementation Put the new practices in place at selected implementation sites; and use feedback loops to review data, make decisions and provide feedback on successes and challenges. Technical assistance is provided to enhance fidelity of policies or practices. 4. Full Implementation All initial sites are fully functioning with high fidelity and achieving expected outcomes. 5. Expansion / Scale-up Use lessons learned from first sites, expanding funding, staff, data systems, etc. to all sites. At state-wide implementation, the new practices and supporting organizational structures are institutionalized and become standard practice within the state. Select the option that best describes the status of the implementation of the program or policy:
1. Exploration / Community assessment
2. Develop implementation plan and build capacity
3. Initial implementation
4. Full implementation
5. Expansion / Scale-up
Populations Targeted
Required
Checkbox* Age
�    0-4 years of age
5-11 years of age
12-17 years of age
�    >18 years of age
Setting
required
Checkbox* - School or school district
- Medical or Medicaid
- Hospital / hospital system
- Health plan
- Multi-unit Housing
- Other [describe]
Other Setting Description
optional
Open Text Open Text
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Select the county where the intervention is located. For example, if home visiting program is located in a clinic in County A, and residents from Counties A & B are eligible for services, select County A. Then, enter a new intervention, and select county B. For in-person AS-ME, select the county where the curricula is delivered. If an intervention is potentially available state-wide (e.g., Medicaid policy, or virtual AS-ME targeting anyone in the state, then select statewide. What state is intervention located in?
required
drop-down Select state first to prepopulate the correct counties, then county. Statewide will be first option listed for each list of counties so states can indicate a statewide intervention
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Select the county where the intervention is located. For example, if home visiting program is located in a clinic in County A, and residents from Counties A & B are eligible for services, select County A. Then, enter a new intervention, and select county B. For in-person AS-ME, select the county where the curricula is delivered. If an intervention is potentially available state-wide (e.g., Medicaid policy, or virtual AS-ME targeting anyone in the state, then select statewide. What county is intervention located in?
required
Dropbox Use counties that Sandhya put on SharePoint
Start date (year required) Date field drop-downs Month, day and year fields, and they can fill out as much detail as they can
End date (year required) Date field drop-downs Month, day and year fields, and they can fill out as much detail as they can
Supported (fully or partially) by:
required
Checkbox* - Recipient
- Partner

Sheet 3: Changes in Population (PM H)

PM H: Changes in Population-level Outcomes PM H: Changes in Population-level Outcomes






Documented changes in intermediate and long-term outcomes (e.g., attack prevalence, hospitalization or ED visits for asthma, lower costs) at a population level (e.g. county, state, health plan) over time.

<Linkage Activity Selection - no actual title> Check all outcomes on which there are documented changes at a population level
(have check-boxes for each, plus open-ended box for Other)
Describe baseline estimates
This should list the label 'baseline' and have open text field
Describe baseline date
This should list the label 'baseline date' and have open text field
Describe follow-up estimate
This should list the label 'follow-up' and have open text field
Describe follow-up date
This should list the label 'follow-up' and have open text field
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: For this item, population is defined as a group of distinct individuals in a jurisdiction, such as a state or county; but also a health plan, school, or some other unit where change has been monitored and observed over time. Population level
Select the level of change these estimates describe.
This should be drop down or radio button
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP) Hover instructions: Describe the specific population selected. For example, if school was selected, enter the school or school district that the results describe. Describe the selected population.
This should be open text
Source of data
This should be open text
Checkbox Attack Prevalence Baseline ______ Baseline Date: ___ Follow-up: ______ Follow-up Date: ______ -County
-state
-health plan
-school
-other
Open-ended Open-ended
Checkbox Hospitalizations Baseline ______ Baseline Date: ___ Follow-up: ______ Follow-up Date: ______ -County
-state
-health plan
-school
-other
Open-ended Open-ended
Checkbox ED visits Baseline ______ Baseline Date: ___ Follow-up: ______ Follow-up Date: ______ -County
-state
-health plan
-school
-other
Open-ended Open-ended
Checkbox Lower costs Baseline ______ Baseline Date: ___ Follow-up: ______ Follow-up Date: ______ -County
-state
-health plan
-school
-other
Open-ended Open-ended
Checkbox Other ( + field to describe) Baseline ______ Baseline Date: ___ Follow-up: ______ Follow-up Date: ______ -County
-state
-health plan
-school
-other
Open-ended Open-ended

Sheet 4: Use of Eval Findings (PME)

PM E: Use of Evaluation Findings

Actions taken or decisions made during the reporting period to improve program activities and increase program effectiveness as a result of evaluation findings.




Response type Response options (if applicable)
Type of action taken
Required
Checkbox Checkboxes (underlines are for headings for categories, and not to have checkboxes):
Accountability
Improvements to contract monitoring
Commitment to equity issues
Developing or reaching program targets
Program Improvement
Revise future program plans
Specific improvements to existing interventions
Surveillance or Evaluation Improvements
Enhance surveillance systems or reports
Specific improvements to data collection or program monitoring
Infrastructure Improvement
Address policy gap/issue
Expand partnerships
Increase collaboration
Scaling up intervention
Enhance or revise communication plans
Resource Allocation / Sustainability
Changes to funding allocation or expenditure
Steps to ensure sustainability of intervention
Economic evaluation (e.g., planning, conducting, or using results of)

Other
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: List the evaluation or evaluations that were used to produce these findings upon which action was taken. Evaluation name(s)
Required
Open Text n/a
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: Select the program/intervention topic(s) that the evaluation was designed to assess. Evaluation Topic(s)
Check all that apply.
Required
Checkbox Checkboxes:
E: Asthma self-management education
X: Reducing smoking and exposure to secondhand smoke
H: Home visiting programs
A: Achieving guidelines-based medical management
L: Linkages across settings, including care coordination
E: Environmental strategies to reduce asthma triggers from indoor, outdoor, and occupational sources
Infrastructure
Partnerships
Communications
Surveillance
Other
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: List the evaluation question that produced the findings that were used to take action (not the findings or actions themselves). Evalution Question(s)
Required
Open Text n/a
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instruction: Describe the findings that prompted actions (not the actions themselves). Evaluation Findings
Required
Open Text n/a
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: Describe the actual programmatic actions that were taken as a result of the evaluation findings described above. Programmatic Action(s)
Required
Open Text n/a
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: Learning and Growing recommends and provides a template for an action plan to guide stakeholders in using evaluations findings for program improvement. Choose yes if program and evaluation staff worked together to develop a written action plan based on the findings described above. Was a written action plan developed with program staff to address the evaluation findings?
Required
Drop-down or radio button Yes/No

Sheet 5: Linking Activities (PMB)

PM B: Linking Activities and Outcomes
Documented activities of the recipient, and outcomes achieved, to establish and/or expand linkages between components of the EXHALE technical package at the organizational level (e.g., linkages that promote reimbursement or referrals; systems to share information across providers; mechanism to link health plans with home-based services or schools, data sharing across sectors)





<Linkage Activity Selection - no actual title> Linkage Activities

Status of Efforts
These should be drop downs or radio buttons
<title varies by linkage activity>
These options should be checkboxes
Associated Outcomes
These options should be checkboxes
Checkbox Linkages around coverage or reimbusement of services (i.e., worked with a payor(s) to provide or reimburse for asthma self-management education and/or home visits)
-New linkage effort
-Expanded existing effort to provide coverage or reimbursement of more services ot to more payors
-Linkages haven't changed since previous reporting
Associated Payors? Check all that apply

State Medicaid;
Medicaid Managed Care plan(s);
State employees health plan;
Private health plan;
Other (+ field to describe)
Check all that apply
-Established dialogue with specific payor around these issues
-Payor put mechanism in place to provide or reimburse for these services
-Criteria for referral to these services established
-Payor is providing or reimbusing for services
-Other [Describe]
Checkbox Linkages between health care and community services. The recipient faciliated linkages between health care systems, providers or payor(s) and other service providers (other than coverage or reimbursement) -New linkage effort
-Expanded existing effort to provide coverage or reimbursement of more services ot to more payors
-Linkages haven't changed since previous reporting
Efforts are to link which health care providers and community services?
Check all that apply .

Health care organizations or providers and schools,
Health care organizations or providers and community asthma services
Health care organizations or providers and other community services (transportation, housing, legal, etc)
Other [describe]
Check all that apply
'- Facilitated referrals and follow-up
-Faciliated systematic information sharing
-Other (describe)
Checkbox Linkages with other state-level programs or agencies. The recipient engaged other state-level programs or agencies to expand access to and coordination of EXHALE strategies -New linkage effort
-Expanded existing effort to provide coverage or reimbursement of more services ot to more payors
-Linkages haven't changed since previous reporting
With what state-level program or organization did you link?
Check all that apply:

Department of Education
State housing authority
Tobacco control program
Another public health program: [Open-ended]
Other: [open-ended]
Check all that apply
'-Established systens to promote cross agency referrals of people with asthma
-Achieved adoption of asthma-friendly policies by the other program or agency
-Shared relevant data about program reach and activities between the recipient and other programs or agencies (e.g. children with asthma in smoke-free housing, completed referrals of people with asthma to smoking quit lines)
-Implemented HIPAA and FERPA compliant methods of sharing information about individuals with asthma across agencies
'-Other [please describe]
Checkbox Linkages with systems providing comprehensive, coordinated care. The recipient worked to incorporated comprehensive asthma care into existing mechanisms for care coordination. -New linkage effort
-Expanded existing effort to provide coverage or reimbursement of more services ot to more payors
-Linkages haven't changed since previous reporting
What was the existing mechanism or organization for care coordination?
Check all that apply

Patient-centered medical homes
Children's hospital
Other (non-children's) hospital or health system
Community Health Worker (CHW) training
Disease management or care coordination program
Other [ describe ]
Check all that apply
'-Provided training or input into training materials around asthma
- Provided input into system flow or protocols for asthma
- Provided input or other TA on policies related to asthma
- Provided assistance with evaluation or quality improvement around asthma services
- Other [define]

Sheet 6: Quality of Guideline (PMD)

PM D: Quality of Guidelines-Based Care
Documented improvements in the quality of care or health outcomes (e.g., asthma control; emergency department visits; hospitalizations; asthma self-management education) as a result of Quality Improvement (QI) initiatives.










Data Field/Question Response type Response options (if applicable)










Are you reporting on a QI initiative with baseline and follow-up data? Drop down or radio button -Yes
-No, baseline and follow-up data for at least one process or outcome measure are not yet available. (Document activity in annual report)











Name of HCO or entity conducting QI Open text n/a










Type of HCO Checkbox Hospital System
• Inpatient hospital
• Hospital-based outpatient
• Health system
• Emergency department

Clinic or Community-based center
• FQHC (Federally Qualified Health Center)
• SBHC (School Based Health Care)
• Community Health Center
• PCMH (Patient-Centered Medical Home)
• Private practice or group
• Other primary care setting
• Urgent care
• Public health department

Payers (private or public)
• State Medicaid agency
• Medicaid managed care organization
• Other health plan











Type of HCO_other_description Open text n/a










Location of HCO drop-down State and county










Settings for QI - In how many settings (e.g., 2+ FQHCs) was QI conducted? drop-down • 1 setting
• 2-4 settings
• 5-7 settings
• 8+ settings
• Don't know











Approximately what proportion of the patients with asthma are children (0-17 years of age) in this setting? drop-down • All or nearly all
• Most
• Less than half
• None or very few
• Information not available











Was the QI process facilitated by an outside contractor or organization? drop-down • No, it was internal
• Yes, by the American Lung Association
• Yes, by the American Academy of Pediatrics
• Yes, by the American Academy of Family Medicine
• Yes, by the National Institute for Children’s Health Quality (NICHQ)
• Yes, by another organization











Role of recipient in this QI process
Select all that apply
Checkbox
• No specific role; received information from a partner
• Provided full or partial funding
• Advised on QI process
• Provided training
• Reviewed plans or provided other TA











What did the QI process involve?
Select all that apply.
Checkbox • Changes to other (non-EHR) systems and processes
• Engagement of an interdisciplinary team in the QI process
• Use of PDSA (Plan, Do, Study, Act) cycles
• Expansion of team-based asthma care
• Training of health care providers
• Training of health care staff
• Eliminate barriers for obtaining and using asthma medications and devices
• Encourage use of administrative data to develop systems to improve asthma control
• Encourage shared decision making between patients and providers
• Other











Baseline and Follow-up time frame for QI evaluation
Baseline dates covered by QI evaluation: _____
Open text n/a










Follow-up dates covered by QI evaluation: _____
Open text n/a










Does the time frame entered above apply to all process and outcome results provided? Y/N NOTE: Default to Y










If follow-up data are not yet available, provide a date when they are anticipated: _________
Open text n/a










Process measures collected
For each collected, indicate whether follow-up data indicated an improvement, no change, or worsening.
label label










Assessment of asthma severity
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Assessment of asthma control
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Appropriate prescribing of asthma medications/devices
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Use of spirometry
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Provision of asthma action plans
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Assuring effective inhaler technique
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Provision of education around asthma triggers
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Other asthma self-management education
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Influenza vaccination
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Measures to assure follow-up
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











HC facility compliance with care path or protocol
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Referral to smoking cessation services
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Referral to other home or community services
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Other
Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Health outcomes collected (if available)
For each collected, indicate whether follow-up data indicated an improvement, no change, or worsening.
label label










Asthma control using a standardized test Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Appropriate medication use Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Asthma attacks/episodes Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Asthma Hospitalizations Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Asthma ED visits Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Other athma-related urgent or unscheduled visits Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Asthma related quality of life Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Other Dropdown or radio button - Improvement
- No significant change
- Worsening
- Follow-up data not yet available











Is a report on the QI process/evaluation available? Dropdown or radio button - Report online
-Available upon request











if so, enter URL of online report (if applicable) Open text n/a











Sheet 7: AS-ME and Improvement (PMFG)

PM F: AS-ME Completion Rates


Number and demographics of people with asthma who initiated and attended at least 60% of sessions of guidelines-based asthma self-management education (AS-ME); and description of the setting and curriculum of AS-ME courses.
PM G: Improvement in Asthma Control among AS-ME Completers
The number of participants with poorly controlled asthma on enrollment (a subset of the previous measure) who report their asthma is “well-controlled” one month or more after attending at least 60% of asthma self-management education sessions.





Response type Response options (if applicable)
Partner Delivering Asthma Self-Management Education (AS-ME)
Do not include AS-ME delivered as part of a home visit.
Open-ended n/a
Program Used
Drop down or radio button -Breathe Well, Live Well
- Kickin' Ashthma
- Open Airways in Schools
- You Can Control Asthma
- Wee Breathers
- Other

Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: Each setting is unique and the most appropriate option should be selected. For example, if delivered in a community clinic, select health care setting; if in a school clinic, select school. However, if the curriculum was delivered in more than one setting (one session in a school, and one in a health care setting), select all options that apply. Program delivery setting(s): Checkbox - School
- Health care delivery setting (non-school setting)
- Community setting (non-school)
- Virtual/web-based

Choose the county in which the program was delivered
Drop down or radio button Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: Use [tool] to convert the address of service provision into latitude or longitude points State and county drop-downs
County - Latitiude
open text n/a
County - Longitude open text n/a
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Definition of in-person settings include interactive sessions held virtually (e.g., video conference). Were there two or more in-person sessions? Drop down or radio button Yes/No
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Definition of return demonstration (in hover over or linked pop-up): Proper use of prescribed inhaled therapy means that the should patient master the correct technique for preparing and activating a device and inhaling medication effectively. Providers should demonstrate to patients how to properly adminster medications using inhalers, including use of spacers when appropriate and placebo inhalers if available. Patients then demonstrate the techniques using their own devices. Was a return demonstration part of the curriculum? Drop down or radio button Yes/No
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: Navigate to the National Heart, Lung, and Blood Institute (NHLBI), National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma at https://www.nhlbi.nih.gov/sites/default/files/media/docs/asthgdln_1.pdf Did the curriculum contain all of the components listed in the NAEPP guidelines (including basic asthma facts; understanding medication differences; and patient skills in taking meds, managing environmental exposures, action plan, and self-monitoring)? Drop down or radio button Yes/No
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Indicate the level of support provided by the state asthma control program for this curriculum delivery State asthma program (SAP) support
(Check all that apply)

Options (check all that apply):
Fully or partially funded by SAP
Provide technical assistance, training, and/or resources

Test used to measure asthma control
(Select all that apply):
Checkbox -ACT
- Cact
- ATAQ
- ACQ
- Other
- Unknown

NEW SECTION HEADER: Patient Enrollment Information - Enter the number of participants initiating AS-ME label label
Asthma control status on enrollment label label
Number of participants (upon enrollment) with any hospitalizations OR ED visits for asthma in the 12 months prior to enrollment open text, if possible desingate as a number field

Number of participants (upon enrollment) without any hospitalizations OR ED visits for asthma in the 12 months prior to enrollment open text, if possible desingate as a number field

Number of participants (upon enrollment) with no information on asthma control within the 12 months prior to enrollment open text, if possible desingate as a number field

Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: If follow-up estimates are not yet available, provide your best estimate as to when results may be expected. NEW SECTION HEADING: Patient Follow-up Information
label label
Kuiper, Nicole M. (CDC/ONDIEH/NCCDPHP): Hover instructions: If follow-up estimates are not yet available, provide your best estimate as to when results may be expected. Are follow-up data available? Drop down or radio button Yes/No

If not, when are estimates expected?
<Month field>
Drop down or radio button Jan
Feb
Mar
April
May
June
July
Aug
Sept
Oct
Nov
Dec

If not, when are estimates expected?
<Year field>
Drop down or radio button 2019
2020
2021
2022
2023

Number of participants attending at least 60% of sessions label label
Number of participants at enrollment whose asthma is Well-controlled
open text, if possible desingate as a number field n/a
Number of participants at enrollment whose asthma is Poorly-controlled
open text, if possible desingate as a number field n/a
Number of participants at enrollment with no information on asthma
open text, if possible desingate as a number field n/a
Age of participant (person with asthma) upon enrollment:
label label
Number of participants aged 0-4 open text, if possible desingate as a number field n/a
Number of participants aged 5-11 open text, if possible desingate as a number field n/a
Number of participants aged 12-17 open text, if possible desingate as a number field n/a
Number of participants aged 18-65 open text, if possible desingate as a number field n/a
Number of participants aged 65+ open text, if possible desingate as a number field n/a
Number with age unavailable open text, if possible desingate as a number field n/a
Of those attending at least 60% of sessions who had poorly controlled asthma at enrollment, how many reported well controlled asthma one month completion of the program?
Enter whole number, or option to click a dropdown for "data unavailable" or "data pending"
New Section


How many individuals with asthma received AS-ME as part of a home visiting program during the performance year? open text, if possible desingate as a number field n/a
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File Modified0000-00-00
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