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.

GIST was a developed by statewide team of experts in asthma and practice redesign, and created a set of tools and a program to implement them, led by the Michigan Department of Health and Human Services Asthma Program. The GIST Stepwise Approach was updated with information from the 2020 Focused Updates to the Asthma Management Guidelines: A Report from The National Asthma Education and Prevention Program Expert Panel Working Group.

You are welcome to use the GIST materials to improve asthma care in your practice or in any other way. Use this implementation guide to help make the implementation easier and more effective. For more information about GIST, contact Tisa Vorce vorcet@michigan.gov.

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 e-action plans with all possible meds/doses for age groups, and customize it for your practice, or choose another action plan.
• 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.

Medications

• Pocket-sized medication guides for clinicians

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.

A practice may also call the DME directly with the script, then the DME mails or delivers the device to the home.

Patient Handouts

• Patient handouts on many topics (triggers, medications, insurance, devices, warning signs, etc.) in a printable, easy-to-understand format from the Michigan Asthma Resource Kit (MARK)

Managing Asthma Through Case Management in Homes (MATCH)

MATCH programs provide in-home asthma case management for people with moderate to severe persistent asthma in certain communities. These visits may be a health plan benefit.

Practice Redesign

• Find out how one practice has improved care and outcomes for its asthma patients and increased practice revenue at the same time
• Use a sticker to help document patient status and needs

Other Resources

• Learn more about diagnosing and managing asthma
• Primary Care 15-minute Asthma Visit Infographic and resources to help clinicians provide guidelines-based asthma care in a 15 minute visit.
• Questions to help clinicians determine personal health beliefs (pdf)