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American Board of Family Medicine

"The certifying boards in the United States several years ago adopted a concept called Maintenance of Certification, which now requires clinicians to do something continuously to maintain their specialty certificate. So what we have done is gone back and retrofitted, if you will, our asthma module to emphasize some of the key messages from the NAEPP."

Michael D. Hagen, M.D., Senior Vice-President, American Board of Family Medicine (Lexington, KY)

Michael D. Hagen, M.D. discusses how the American Board of Family Medicine is developing innovative approaches to asthma education and practice improvement.

Project Snapshot

With funding from the National Asthma Education and Prevention Program's (NAEPP) National Asthma Control Initiative (NACI), the American Board of Family Medicine (ABFM) updated and used its Maintenance of Certification for Family Physicians Asthma Self-Assessment Modules (SAMs) to educate primary care physicians on using key evidence-based recommendations from the NAEPP's Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma (EPR-3). Helping physicians stay abreast of the latest guidelines and best practices for improving asthma care is critical. In the United States, more than a quarter of all physician office visits for lung disease in 2009 were due to asthma, according to the NHLBI Morbidity and Mortality Chart Book, which previously estimated physician and other health care services to account for more than a quarter of direct expenditures for asthma care in 2010.

Michael D. Hagen, M.D., at a NACI meeting in Baltimore, MD.
Michael D. Hagen, M.D., at a NACI meeting in Baltimore, MD.

The ABFM initiated its NACI project by updating its online asthma SAM module with the six priority messages of the NAEPP's Guidelines Implementation Panel (GIP) Report. In addition, ABFM created a curriculum for the asthma SAM, which it conducted using trained faculty to guide small groups of family physicians through the module. Working in collaboration with several state chapters of the American Academy of Family Physicians, ABFM conducted the group asthma SAM with family physicians in Colorado, Florida, Oklahoma, and Virginia.

To refine the learning process, the ABFM will continue to follow and compare changes in knowledge and clinical practice between physicians in the group asthma SAM and their counterparts who completed the asthma SAM through ABFM's existing online Maintenance of Certification for Family Physicians (MC-FP) process. Physicians who participated in the MC-FP process were also encouraged to conduct their own chart audits to review how well they provided guidelines-based asthma care in their clinical practice.

Project Goals

  1. Educate family physicians in practical asthma care and familiarize them with the six priority GIP messages.
  2. Evaluate the standard online asthma self-assessment module (SAM) process compared to a facilitated group SAM process in supporting and facilitating specific elements of asthma care.
  3. Understand which aspects of the EPR-3 are conveyed most successfully to primary care clinicians and which messages are more challenging to transmit.

Challenges & Solutions

Challenge: Recruit physicians for group SAM trainings. To conduct and assess the group SAM, ABFM set targets for how many physicians it would recruit for each session. Knowing how difficult it could be to persuade busy physicians to attend in-person trainings, however, ABFM sought ways to broaden its outreach to potential recruits.

Solution: Partner to expand outreach. To meet its training targets, ABFM paired with individual state chapters of the American Academy of Family Physicians to invite physicians in their networks to attend a group SAM activity. The resulting participation in the group SAM generally met or exceeded ABFM's targets. In the one state where attendance in the group SAM was less than desired, ABFM decided to present an additional group SAM session and broadened its outreach to a larger pool of physicians.


ABFM partnered with the Colorado, Florida, Oklahoma, and Virginia Academies of Family Physicians to provide group asthma SAM sessions to family physicians in those states.

Kurt Elward, M.D., M.P.H., discusses project monitoring and evaluation during a NACI meeting in Baltimore, MD.
Kurt Elward, M.D., M.P.H., discusses project monitoring and evaluation during a NACI meeting in Baltimore, MD.


ABFM shared and collaborated with other NACI-funded projects to advance asthma care best practices. For example:

ABFM partnered with Kurt Elward, M.D., M.P.H., from the Medical Society of Virginia Foundation's NACI Demonstration Project to test the group SAM in six states.

ABFM worked with the Kentucky Ambulatory Network, a primary care practice-based research network, to refine the ABFM project's evaluation components.

ABFM used online physician training and maintenance of certification to help meet its project goals.

Other NACI-funded projects that used ABFM-type approaches are:

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Last Updated January 2013