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Fall, 2010

NACI Partner Profile

Helping Healthcare Professionals Get the GIST of Asthma Guidelines

To asthma researchers from the Michigan Department of Community Health Asthma Prevention and Control Program—and its partners from the Asthma Initiative of Michigan—getting to the main point is the crux of their new Asthma Guideline Implementation Steps and Tools (GIST) program.

“We were looking for an acronym that captured what our program was doing: getting to the guts of the asthma guidelines,” said Tisa Vorce, GIST Project Coordinator, and the source of the acronym.

Definition of Gist The main point or part: essence (Source: Merriam Webster Dictionary)

“The mission of GIST is to create simple tools to be incorporated into physicians’ practices,” said Sarah Lyon-Callo, MA, MS, GIST Program Leader and asthma investigator. “It’s about honing it down to the most important elements of what needs to be done to diagnose and treat an asthma patient when they come in for an appointment.”

GIST is one of 13 nationwide asthma demonstration projects that received funding through the National Asthma Control Initiative to develop, implement, and test science-based approaches to improve asthma control using evidence-based information from two reports by the National Asthma Education and Prevention Program: the Expert Panel Report 3—Guidelines for the Diagnosis and Management of Asthma, and its companion, the Guidelines Implementation Panel (GIP) Report

The GIP Report set forth six priority messages to help health care providers improve asthma control and care. GIST has developed simple steps and tools (in the box to the right) to help clinicians and health care providers incorporate all six of those GIP Report messages into everyday practice.

Vorce and her colleagues credit the Connecticut Easy Breathing Program with inspiring their approach.

The GIST project will be implemented this fall in two practice sites; two other practices will serve as control groups.

Half will be lower-income clinics with at least a 50 percent Medicaid patient population, while the remainder will be private practices. They will report back various statistics at regular intervals.

“It’s not about sending physicians asthma guidelines that they have already seen—it’s about providing the entire practice with tools and metrics that they can tailor and use every day,” said Lyon-Callo.

GIST: Guidelines Implementation Steps and Tools

1. “Questions About Your Breathing” and “Asthma Control Test™” (ACT): While in the waiting room, a new patient receives the Questions About Your Breathing form (new tool) to fill out while a returning asthma patient is asked to complete an Asthma Control Test™ (existing tool).
GIP Message: Assess Asthma Control

2. “Asthma Diagnosis Tool” and “Asthma Patient Follow-Up Tool”: The health care provider uses the Asthma Diagnosis Tool to determine (or rule out) asthma and to assess severity in asthma patients not on long-term control medications (to initiate therapy), and uses the Asthma Patient Follow-Up Tool to assess asthma control in returning asthma patients (to maintain or adjust therapy).
GIP Messages: Assess Asthma Severity; Assess Asthma Control

3. “Stepwise Approach to Managing Asthma”: Printed for providers on the flip side of the diagnosis and follow-up tools is a staircase-style chart (by age group and steps of care) to guide what medication, patient education, environmental control measures, and other approaches to advise based on the results of step 2.
GIP Messages: Use Inhaled Corticosteroids; Control Environmental Triggers

4. Medications and Written Asthma Action Plan: Following completion of steps 1?3, the patient is prescribed medication as appropriate, including inhaled corticosteroids for persistent asthma, and an asthma action plan to guide daily and emergency care.
GIP Messages: Use Asthma Action Plan; Use Inhaled Corticosteroids; Schedule Periodic Visits

Last Updated February 2011

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