Asthma Care Processes and Services for Low-Income Populations: Domains, Domain Definitions, Items, and Supporting References.

Processes of Asthma Care domains, definitions, and items*	References
Self-Management Support: assisting patients in taking a central role in their self-care
1. Ensure that patients are taught proper technique when spacers are dispensed	NAEPP 1997
2. Make peak flow meters available at low cost to enrollees	NAEPP 1997
3. Make spacers available at low cost to enrollees	NAEPP 1997
4. Make nebulizers available for rent or purchase at low cost to enrollees	NAEPP 1997
5. Make asthma care plans readily accessible to primary and acute care providers	NAEPP 1997
6. Prepare individualized written asthma care plans	NAEPP 1997; NAEPP 1995; Lieu, Quesenberry,  Capra et al. 1997
7. Provide self-management support through referral to a designated asthma nurse or educator	NAEPP 1997; NAEPP 1995; Gallefoss and Bakke 1999
8. Promote self-management using problem-solving and patient empowerment methodologies	Clark and Gong 2000
9. Assess self-management needs of asthma patients by questionnaire or computer	NAEPP 1997; NAEPP 1995; Clark and Gong 2000
Delivery System Design: designated roles and structures for proactive care
1. Ensure assignment of all patients to primary care provider	Sox et al. 1998; Christakis, Mell, Koepsell et al. 2001
2. Systematically promote continuity of care in appointment-making	Sox et al. 1998; Christakis, Mell, Koepsell et al. 2001
3. Make an effort to have the primary care provider see patients who make same-day appointments	Sox et al. 1998; Christakis, Mell, Koepsell et al. 2001
4. Ensure follow-up in primary care clinic after an acute visit in an urgent care setting	NAEPP 1997, Sin et al. 2002
5. Promote appointments for preventive chronic asthma management visits	NAEPP 1997; Stout, White, Rogers et al. 1998;  Greineder, Loane and Parks 1999; Fardy 2001
6. Use asthma nurses, educators, or lay outreach workers to provide asthma case management	NAEPP 1997; Wissow et al. 1988; Stout, White, Rogers  et al. 1998
Information Systems: tracking and reminder systems
1. Provide reminders to providers about asthma guideline adherence for individual patient encounters	Feder, Griffiths and Highton 1995; Bordley 2001
2. Give feedback reports to providers to improve performance in asthma care	Palmer 1985; Heinrich and Homer 1999
3. Provide clinician lists of asthma patients in their panels (registries)	Newacheck, Stein, Walker et al. 1996
4. Use asthma registries that prompt clinicians about appropriate medications or services	Feder, Griffiths, Highton et al. 1995
Decision Support: assisting providers with treatment decisions
1. Promote two-way communication between specialist and primary care provider	Newacheck et al. 1994; Newacheck, Stein, Walker et al. 1996
2. Facilitate allergy or pulmonology consultation for difficult asthma cases	Cooper and Kuhlthau 2001
3. Promote the use of evidence-based asthma guidelines	NAEPP 1997; Ting 2002
4. Involve allergists or pulmonologists in improving primary care for children with asthma	NAEPP 1997
5. Offer asthma education to primary care providers and nurses	NAEPP 1997; NAEPP 1995
Community Linkages: partnerships between the  practice site and community resources
Coordinate asthma care with appropriate community resources, such as school nurses	NAEPP 1997
Health system: measures taken by the organization to  facilitate chronic illness care
Use contractual incentives to motivate providers to improve asthma care	NAEPP 1997
Processes of Care Targeting Low-Income Populations: Domains and Items
Cultural Competency: addressing ethnic and  cultural barriers
1. Recruit ethnically diverse nurses and providers	Cooper-Patrick, Gallo, Gonzales et al. 1999; Saha et al.  2000; Centers for Medicare & Medicaid Services  2003b.
2. Attempt to minimize cultural barriers to care through use of printed materials or waiting room posters depicting different ethnic or cultural groups	NAEPP 1995; Centers for Medicare & Medicaid Services  2003b.
3. Offer cross-cultural health inservices or diversity training to staff and providers	Van Ryn and Burke 2000; AAP Committee on Pediatric  Workforce 1999
4. Evaluate the level of cultural competency among staff and providers	Landon and Epstein 1999; Elixhauser 2002; Schneider,  Zaslavsky and Epstein 2002
Communication: enhancing health communication with low literacy populations and non-English speakers
1. Have ready access to a defined pool of skilled medical interpreters	Baker, Parker, Williams et al. 1996; Hornberger, Gibson,  Wood et al. 1996; Morales, Cunningham, Brown et al.  1999; Centers for Medicare & Medicaid Services 2003a.
2. Provide telephone support in patients native language for non-English speakers	Baker, Parker, Williams et al. 1996; Hornberger, Gibson,  Wood et al. 1996; Morales, Cunningham, Brown et al.  1999
3. Recruit bilingual nurses and providers	Cooper and Kuhlthau 2001; Centers for Medicare & Medicaid Services 2003a.
4. Provide health education materials oriented to patients/parents with low literacy skills	NAEPP 1995; Weiss and Coyne 1997; Ad hoc committee  on literacy 1999; Williams et al. 2002
5. Offer training to staff and clinicians to develop communication skills such as working with non-English speakers (through interpreters) or patients with poor literacy skills	Weiss and Coyne 1997; Ad Hoc Committee on Literacy  for the Council of Scientific Affairs 1999; Weinick and  Krauss 2000; Williams et al. 2002
Empowerment Definition: providing patients with tools to access care effectively
1. Promote an understanding of health services and managed care policies through written material aimed at Medicaid or low-income enrollees, including posted statements of patient rights and responsibilities	Newacheck et al. 1994; Newacheck, Stein, Walker et al.  1996; Gerteis, Harrison, James et al. 2000
2. Pro-actively orient new enrollees	Newacheck et al. 1994; Newacheck, Stein, Walker et al.  1996; Gerteis, Harrison, James et al. 2000
3. Designate a staff member(s) to assist low-income patients in navigating the system and to advocate for them	Gerteis, Harrison, James et al. 2000

^*All items were asked with the root: “How routinely does your practice site…?”