Emerging Practices in Medicaid Primary Care Case Management Programs. Appendix B: North Carolina Access II & III Core Elements of the Asthma Disease Management Program


Build Capacity for Routine Assessment of Asthma

  • Adopt the NIH (National Institute of Health) guidelines.
  • Develop a method for identifying and recruiting asthma patients in the participating provider network.
  • Develop and implement a simple questionnaire that allows providers to quickly stage the severity of an asthmatic patient.
  • Develop a method to record severity staging on a regular basis.
  • Establish peak flow meter readings as a tool for all asthma patients, and the peak flow at all appropriate times and in all appropriate settings.
  • Record each patient's personal best peak flow in the medical record and/or the care management plan.
  • Stock peak flow meters and spacers in all providers' practices and care settings to assure availability and ease in dispensing to patients.
  • Use spacers/holding chambers, when appropriate.
  • Identify one staff person per practice as the "asthma QI champion."

Reduce Unintended Variation in Care and Establish Consistency of Care

  • Educate all medical personnel regarding the proper use of anti-inflammatory medications.
  • Use anti-inflammatones and/or inhaled corticosteroids for stage II, III and IV asthmatics.
  • Focus educational effort on clinicians not using the correct medications when appropriate.
  • Educate all medical personnel regarding the step approach to asthma management based on NIH guidelines.
  • Offer physician profiling as a part of this effort. Conduct detailed visits with staff and physicians to review each practice's prescribing histories, including a case-by-case discussion of diagnoses and recommended medications.
  • Utilize case managers to coordinate information gathering, transfer, and care delivery as appropriate.
  • Assess home environment for smoking, allergenic materials, and other known asthma triggers. Coordinate sharing of this information with all care givers.
  • Educate all medical personnel to stage asthmatics appropriately and write an asthma action plan accordingly.

Build Capacity to Educate Patients, Families and School Personnel About Asthma

  • Develop and implement simple asthma management plans that include the patient performing and monitoring peak flows.
  • Develop the capacity to teach each child and family how to properly use peak flow meters, inhalers, spacers and/or holding chambers.
  • When possible, collaborate with school nurses, teachers, administrators, and day care personnel to assure appropriate education, assessment, and treatment for school-age children with asthma.
  • Encourage self management of diseases.
  • For young children who cannot use peak flow meters — educate family on symptom-based management.

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