Asthma Guideline Implementation Steps & Tools (GIST)

The Asthma Guideline Implementation Steps & Tools (GIST) project was funded in 2010 by the National Asthma Control Initiative (NACI) to develop a program that makes it easier for primary care clinicians to use the NHLBI asthma guidelines in their everyday care of patients with asthma. The Michigan Department of Community Health gathered a statewide team of experts in asthma and practice redesign, and created a set of tools and a program to implement them. Seven practices have implemented asthma QI activities including GIST with encouraging results.

In 2011, NACI funded a second phase for GIST, using asthma champions to promote GIST with health professional audiences, and new practices are welcome to use the GIST materials to improve their asthma care. Use this implementation guide to help make the implementation easier and more effective. For more information about GIST, send a message to info@getasthmahelp.org.

GIST Materials can be individualized to suit your organization/practice

  • Questions About Your Breathing – A tool to help patients provide info about their breathing symptoms and history
  • Questions About Your Breathing in Spanish
    • Given to patients being seen for respiratory complaints, no current diagnosis of asthma
    • Usually given to patient before seeing clinician
  • Asthma Control Test™ – A validated tool to assess patient's level of asthma control
    • Usually given to diagnosed asthma patient before seeing clinician
    • Score can be used as part of control assessment
    • Available in English adult and child versions, and Spanish adult and child versions.
  • Asthma Diagnosis Tool – To help clinician diagnose asthma and assess severity
    • Clinician uses with patient being seen for respiratory complaints
  • Asthma Patient Follow-Up Tool – To help clinician assess level of asthma control then take steps to maintain, increase or decrease treatment
    • Clinician can use with patient being seen for symptomatic asthma visit, scheduled asthma visit, or visit for other reason
  • Stepwise Approach to Managing Asthma – To help clinician determine medication needs and management approach
    • Use steps as initiated on Diagnosis and Follow-Up Tools to determine medication type and dosage, adherence and environmental checks
  • Asthma Action Plan – No set plan for GIST, but many good plans available if needed. Download an electronic pdf-based plan with all possible meds/doses for age groups, and customize it for your practice.
    • Use the development of the action plan as an opportunity for patient education about asthma triggers, medications, devices, barriers, etc.
  • GIST implementation summary slide

GIST Implementation and Asthma Practice Resources

  • Asthma Action Plans
    • AIM electronic AAPs are available as writable PDFs in 3 age groups: 0-4, student (5-18) and adult. They include all the possible medications and dosages for each age group and can be customized for your office by inserting practice information at the top and pre-setting any standard directions. Other asthma action plans are also available – if you are looking for something standard or special, such as an extremely simple plan, or one in Spanish.
    • University of Michigan Health System electronic AAP is available as a writable PDF, including all the possible medications and dosages for each age group. Customize it for your office by changing the practice name at the top and pre-setting any standard directions.
  • Medications
  • Spacers/Valved-holding Chambers (VHCs)
    • Spacers/valved-holding chambers are an important part of medication delivery, but can be hard for patients to access. Michigan Medicaid plans now allow 4 spacers/VHCs each year, at the pharmacy, with no prior authorization. Fee for service members can have any device that is Aerochamber® brand. Learn more about spacer/VHC access.

      This is how it works:
      1. The clinician sees a need for a device, takes one out of the closet and gives it to the patient, along with education about its care and use.
      2. The patient/parent signs the DME form, and the practice faxes the form back to the DME, who has contracts with health plans to get reimbursement.
      3. The clinic doesn't handle any money, just acts as a distributor.

      This only works for clients with insurance, but has worked well for patients who have Medicaid.

      An alternative plan: call the DME directly with the script, then the DME mails or delivers the device to the home.
  • Patient Handouts
  • Managing Asthma Through Case Management in Homes (MATCH) – available in 5 Michigan communities (Grand Rapids, Genesee, Wayne, Macomb and Ingham Co.), MATCH programs provide in-home asthma case management for people with moderate to severe persistent asthma. These visits may be a health plan benefit.
  • Practice Redesign
  • Other Resources