CHADIS Asthma Toolkit

The CHADIS Asthma Toolkit includes many tools for assessment, monitoring functionality, and intervention for asthma patients and their families.  Unique functionality integrates patient-entered pre-visit data with decision support to facilitate NHLBI guideline-based care (Asthma Patient Specific Template or Asthma PST) and results in patient-specific education, populates Asthma Action Plans and provides between-visit symptom monitoring options (see below). MOC-4 credits are available for associated quality improvement activity.

 

Tools for Initial Asthma Assessment

 

  • (PACCI):  The PACCI documents Pediatric Asthma Control & Communication InstrumentNHLBI guidelines and as needed for proper prescribing. It provides a validated control score similar to the  Asthma Control Test (ACT).  PACCI has been validated in both English and Spanish and in Medicaid insured populations. Graphical representation of severity over time appears in the PST and can be used in shared decision making with families.level of severity/control per

  • Childhood Asthma Control Test (ACT) for Ages 4-11:  This 7-item screen screens for possible problems in control of asthma symptoms. The screen includes 4 items to be answered by the child (with adult assistance as needed) and 3 items for parents.

  • Asthma History:  A tool documenting the patient’s history of birth, subsequent respiratory risk factors, and family history of asthma and allergies.

  • Asthma Priorities: This brief, three-question tool collects information about the parent’s visit priorities and the hardest parts of caring for a child with asthma, which can be used to guide the visit.

  • Asthma Control Parent Perception Rating: The 1-item tool asks the parent to rate asthma symptoms on a colored dial.  This was used in the BOAT study to compare the adult’s perception of asthma control to that of the clinician,  one of the most effective interventions to improve medication adherence.

  • Asthma Trigger Exposure Questionnaire:  This brief (3-10 item) dynamic questionnaire asks about common triggers for allergies or asthma including pollen, molds, animals, dust, foods, cockroaches, and smoke; what actions the family has taken to address these; how changes were informed; and if a flu shot has been received. The "Environmental Triggers and Smoke Exposure Questionnaire" is a more comprehensive alternative tool for this area, assessing all triggers recommended by National Environmental Education Program. 

 

Adolescent Self Report

 

  • Asthma Control Test (ACT) for People 12 Years and Older: This 5-item tool self-assesses asthma symptoms and produces a score.

 

 

Tools for Asthma Monitoring & Addressing Compliance

 

  • Asthma Medications: This tool collects information about prescribed asthma medications, provides medication photos, and assesses adherence as well as barriers to adherence.

  • Pediatric Asthma Control & Communication Instrument (PACCI):  Described above.

  • Childhood Asthma Control Test (ACT):  Described above.

  • Registry of asthmatic patients in CHADIS provided by request.

  • Reports including the new Medicaid CQI measure of the percent of children with persistent asthma on controllers provided by request.

  • Alerts for children under-medicated for their reported severity per National Heart, Lung, and Blood Institute (NHLBI) guidelines, according to PACCI and medication questionnaires completed between visits, can be generated by request.

 

Resources and Decision Support

 

  • Asthma Patient Specific Template (PST) - This unique CHADIS functionality incorporates scored results of the pre-visit tools listed above to provide the following, according to NHLBI guidance:

    • Automatically assigned patient- specific asthma education resources including links to videos modeling correct inhaler and other device use.

    • Problem-solving counseling tips for patient-specific controller adherence counseling.

    • Graphical support for shared decision making with families.

    • A prefilled Asthma Treatment Plan, tailored to the patient to print and appearing in the Care Portal.

    • eChapter about asthma for clinicians by Dr. Sande Okelo, Pediatric Pulmonologist at UCLA.

    • Annotated resources for parents and teens including text, videos, an adult quiz, and asthma education game for children.

 

Asthma Treatment Plan (Asthma Action Plan)

 

  • Asthma Treatment Plan: Using the Asthma PST, a printed plan with color guided sections for well/worse/sick situations is pre-filled with patient and doctor contact information, medication instructions, and a ‘permission to carry form’ with an electronic signature option.  The Treatment plan is provided in the child’s Care Portal to be printed as needed by the family. Specific instructions can be customized in simple or complex plans. Clinicians can update the Asthma Treatment Plan for the patient remotely using the PST as condition changes.

 

Asthma Tool Billing

 

  • Use of validated health monitoring tools such as PACCI can be billed as Patient-Focused Health Risk Assessment Tools and Questionnaires code 96160 (replaced 99420).

  • For a more detailed encounter, including history, physical exam, and decision making, you can also use 99214 or 99215 (for more time/complexity than 99213).

  • If at a well-child visit (V22 code) one also treats an additional problem, such as asthma, you should be able to bill for the extended effort with a 25 extender.
     

 

Well Child Triggered Asthma Review

 

When parents complete a routine priorities questionnaire prior to a routine well child visit, if a prior diagnosis of asthma is endorsed the PACCI can be automatically chained to the presence of an asthma diagnosis.  We have found that parents of 78% of children with persistent asthma attending HSVs did not list "breathing or cough" as a priority. Had only parental priority been used to determine whether to screen for asthma, clinicians may have overlooked 78% of children coming in for HSVs with persistent asthma. Use of a monitoring questionnaire triggered by a known asthma diagnosis can facilitate valid assessment of asthma symptoms and determination of the need for change in management which may be overlooked based only on parent concern during HSVs.  Pre-visit assessments allow scheduling longer visits if asthma is severe and also supports additional billing codes.  Health supervision visits represent a critical opportunity for improving asthma care and compliance with NHLBI management guidelines.