0920-0853 PM Reporting Tool MAY2023

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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)

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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	%

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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

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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

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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

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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]

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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

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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