CHAMPS Implementation

Success implementation of a family-centered, patient-tailored, evidence-based intervention like CHAMPS requires careful planning. The resources in this section will provide your practice with factors to consider as they plan to adopt the CHAMPS intervention.

To learn more about these elements click on the links below:

1. Conducting a Successful Intervention. Define success criteria and identify the factors that lead to success.
2. Establishing an Implementation Team. Create a team to oversee the implementation of the CHAMPS intervention at your practice.
3. Conducting a Cost-Effective Intervention. Learn about the cost-effectiveness evaluation conducted in CHAMPS and develop a plan for sustainable funding.

Conducting a Successful Intervention

"That’s what I would tell other community health centers. It’s really a very win-win situation for you, and your community, and your patients." – CFO CHAMPS Intervention Site

Criteria for Success

The most direct measure of success in the CHAMPS intervention is an improvement in patient asthma health outcomes. This is measured by comparing results of the Asthma Symptoms and Utilization (ASU):Baseline Questionnaire at the first patient visit with the results of the ASU: Follow-Up Questionnaire at the 6-month and 12-month visit.

The CHAMPS intervention can also lead to many other direct and indirect improvements in your patients and practice, such as—

• Greater patient engagement. Families demonstrate a willingness to take an active role in managing their asthma, which leads to proactive (preventative) rather than reactive disease management.
• Improved asthma knowledge throughout the practice. Physicians and care teams provide the highest quality, guidelines-based care for asthma.
• Asthma counselor certification. Asthma counselors pursue formal certification, which bolsters their practice's credibility as an asthma care leader.
• Practice recognition. Practices gain positive publicity by highlighting their efforts to improve asthma in their community via the CHAMPS intervention.

Preparing for Success

A variety of factors influence the success of an intervention like CHAMPS. In general, the CHAMPS intervention is most likely to be successful when the following elements are in place at your practice:

• CHAMPS Implementation Team and an Asthma Champion.
• Supportive and engaged leaders and health care staff at all levels in the practice. Learn more about engaging leaders in this brief CHAMPS e-Learning video.
• Effective mechanisms for internal communications within care teams (horizontal) and across all levels of the organization (vertical).
• Team members with content expertise, credibility with patients and providers, direct lines to leadership, decision-making authority, and developed external networks.
• Balance between quality-care and business interests.
• Plan for identifying barriers to success and developing plans for overcoming them.

Refer to the Essential Elements of Success section of the Manual for more information about how you can ensure the CHAMPS intervention is a successful program at your practice.

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Establishing an Implementation Team

"I think CHAMPS did open the idea of okay, everyone can be a team member in patient care; it’s not just the doctor. The nurse plays a role, even people who work the front desk and reception area. Everyone works as a team to generate the goal that we want." - Physician

Get off to a good start with CHAMPS by creating an implementation team to plan, and oversee, the execution of the CHAMPS intervention in your practice.

The implementation team creates a vision of what the improved childhood asthma management system will look like after implementing the CHAMPS intervention, and communicates this vision to all relevant stakeholders. The team also monitors progress and facilitates the dissemination of successful changes to other sites in the practice. The team meets routinely to assess implementation progress and measures of success.

Before forming a team, solicit the approval and support of the practice’s leadership to implement the CHAMPS intervention.

Form a team that includes experts in focus areas needed for successful and comprehensive practice improvement focused on the care of children with asthma. The minimum recommended team members include:

• Asthma Champion: an advocate for high quality asthma care throughout the organization
• Asthma Counselor: case manager for patients with asthma who provides one-on-one patient-tailored counseling and care
• Information Technology Lead: technical lead who can oversee the integration of the CHAMPS processes and tools into the various electronic management systems at use in the practice

Add additional members to the team who represent other key stakeholders in the practice. Read more about other key roles in the Staff Roles and Job Descriptions section of the Manual.

Once the team is formed, follow these three steps to get started:

1. Define the team’s aim and what the team expects to accomplish, including measures of success; refer to the Essential Elements of Success section of the Manual for more information
2. Develop a thorough understanding of current childhood asthma guidelines
3. Establish a strategy to begin implementing the CHAMPS practice changes 
   
   Demonstrating the cost-effectiveness of evidence-based asthma counseling interventions is essential for the practices that adopt them and for the larger policy environment in which they do business. 
   
   Sustaining an intervention like CHAMPS requires financial resources, in addition to an engaged staff and leadership. For long-term sustainability, practices may wish to engage in a dialogue with health plans and state payers about amending current billing practices to cover these types of services or to bundle payments. However, the specific payer-practice relationship may vary widely within states and across states based on multiple factors, including state reimbursement policies and Medicaid agency regulations. Practices may wish to pursue other types of funding either to start or to continue this type of intervention. 
   
   For more details on sustainable funding models at all levels (federal, state, and local) refer to the Sustainable Funding Models section of the Manual. Also refer to the Value Proposition resources available on AsthmaCommunityNetwork.org.

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Conducting a Cost-Effective Intervention

Demonstrating the cost-effectiveness of evidence-based asthma counseling interventions is essential for the practices that adopt them and for the larger policy environment in which they do business.

Sustaining an intervention like CHAMPS requires financial resources, in addition to an engaged staff and leadership. For long-term sustainability, practices may wish to engage in a dialogue with health plans and state payers about amending current billing practices to cover these types of services or to bundle payments. However, the specific payer-practice relationship may vary widely within states and across states based on multiple factors, including state reimbursement policies and Medicaid agency regulations. Practices may wish to pursue other types of funding either to start or to continue this type of intervention.

For more details on sustainable funding models at all levels (federal, state, and local) refer to the Sustainable Funding Models section of the Manual. Also refer to the Value Proposition resources available on AsthmaCommunityNetwork.org.

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The CHAMPS intervention is designed to accommodate each practice's unique structure by allowing flexibility in implementing the intervention—especially when it comes to facility use, resourcing and staffing—while still providing instructions on the minimum requirements for implementing the intervention effectively.

Follow the links below to access the sections of the Manual that provide guidance on setting up your practice and coordinating the personnel needed to implement the CHAMPS intervention:

• Resource and Facility Recommendations. Prepare your facilities to effectively conduct the CHAMPS intervention. For more details, refer to the Resource and Facility Recommendations section of the Manual.
• Staff Roles and Job Descriptions. Identify the key personnel needed to implement the CHAMPS intervention. For more details, refer to the Staff Roles and Job Descriptions section of the Manual.
• Working With Electronic Health Records. Incorporate health information technology into the CHAMPS workflow. For more details, refer to the Working With Electronic Health Records section of the Manual.

"I think CHAMPS did open the idea of okay, everyone can be a team member in patient care; it’s not just the doctor. The nurse plays a role, even people who work the front desk and reception area. Everyone works as a team to generate the goal that we want." – Physician

Practices implementing the CHAMPS intervention need processes for identifying and engaging ideal patient candidates.

Identifying Patients

The patients most likely to benefit from the CHAMPS intervention are children with moderate-to-severe and poorly controlled asthma, as defined by the National Heart, Lung, and Blood Institute's Guidelines for the Diagnosis and Management of Asthma. We strongly recommend clinicians implement guideline-based care into their practice. Learn more about identifying patients for continuous care in this brief CHAMPS e-Learning video. Learn more about implementing guidelines-based care in this brief CHAMPS e-Learning video.

Patients can be identified and referred to CHAMPS as part of their normal care visits but consider using more proactive approaches to identify patients for the program. For example, identify candidates by reviewing pharmacy records or patient diagnostic registries. Also consider advertising the program within your practice and throughout your community (e.g., posters, flyers, local media).

Use the Asthma Symptoms & Utilization (ASU) Questionnaire to quickly identify patients who are likely to benefit from CHAMPS. Please note, the ASU questionnaire is not intended to diagnose asthma control or severity; it is used only as a screening tool for CHAMPS.

The ASU focuses on the patient's—

• Asthma Symptoms in the previous 4 weeks.
• Asthma-related health care usage (e.g., urgent care visits for asthma, asthma-related hospitalizations) in the last year.
• Medication use for asthma.

Engaging Patients

The CHAMPS intervention is designed as year-long program with multiple visits and points of contact between the health care team and the patient. Then intervention is most successful with families who are committed to attending scheduled visits and implementing the treatment and behavioral changes recommended by the health care team. While it is impossible to guarantee patient commitment and engagement to the intervention, several factors can help lead to engaged families:

• Skilled Asthma Counselor. Patient engagement and retention is strongly influenced by the ability of the asthma counselor to build trusting relationships with families. To learn more about the qualities of a strong asthma counselor refer to the Background and Training section of the Manual here.
• Engagement From Providers. The entire healthcare team needs to support the CHAMPS intervention; patients trust their healthcare providers—an enthusiastic recommendation to participate in CHAMPS will go a long way to boosting patient engagement; learn more about provider engagement in the Essential Elements of Success section of the Manual.
• Emphasis on Personalized Care. The CHAMPS intervention provides a family-centered, patient-tailored approach designed to meet the specific needs of each patient and family; the CHAMPS intervention is personalized to the unique asthma risk factors, environmental exposures, and allergic sensitivities of each child; families are more likely to be engaged if they know the intervention is unique to them; emphasize the personalized aspect of the intervention at every opportunity; learn more about the personalized intervention in the Tailoring the Intervention section of the Manual.
• Patient Incentives. Even with the promise of improved health for their child, keeping families engaged for a year-long program can be challenging. Sometimes additional incentives can be used to help motivate families to stay involved. Incentives can include giving the families the home environment remediation supplies (e.g., HEPA filters, HEPA vacuums). Previous CHAMPS program sites found that giving the families modest gift cards for local merchants was also a way to keep them engaged, at a minimal cost to the practice. 
• Emphasis on Evidence-Based Research. The CHAMPS intervention is based on more than 20 years of evidence-based research in asthma; the components of the intervention have been replicated in controlled clinical trials and in “real-world” primary care practices around the country; emphasize the strong research foundation of CHAMPS with families.

Patient assessment visits are used to evaluate the patient, characterize their asthma, assess their allergic sensitivities, and identify asthma and environmental risk factors. The assessment visits include:

Baseline Clinical Assessment. Collect information on the patient and establish a baseline for comparison; the visit includes—

• A physical examination
• An assessment of asthma symptoms, asthma-related healthcare utilization, and medication use using the Asthma Symptoms and Utilization: Baseline Questionnaire 
• An assessment of pulmonary function; learn more in the Spirometry section of the Manual and by watching this brief CHAMPS e-Learning video
• An assessment of airway inflammation (optional); learn more in the FeNO section of the Manual
• An allergen sensitivity assessment covering a basic panel of the most common indoor environmental allergens; learn more in the Allergen Sensitivity Testing section of the Manual and by watching this brief CHAMPS e-Learning video
• Completion of the Child Asthma Risk Assessment Tool (CARAT); learn more in the CARAT section of the Manual

Learn more in the Baseline Clinical Assessment section of the Manual.

Home Environmental Risk Evaluation. Visit the patient's home to assess environmental risk factors for asthma. Learn more in the Home Environment Assessment section of the Manual. 

6-Month Outcome Assessment. Reassess patient’s asthma symptoms and asthma-related health care usage via physician assessment and the Asthma Symptoms and Utilization: Follow-Up Questionnaire to see if the patient's asthma is improving; learn more in the Follow-Up Assessments section of the Manual.

12-Month Outcome Assessment. Reassess patient’s asthma symptoms and asthma-related healthcare usage via physician assessment and the Asthma Symptoms and Utilization questionnaire to see if the CHAMPS intervention has improved the patient's asthma during the 12-month intervention period. Learn more in the Follow-up Assessments Visit section of the Manual. 

The information collected about the patient during the Baseline Clinical Assessment and Home Environmental Assessment visits is used to create the patient-tailored asthma counseling plan delivered during the asthma counseling sessions. Information collected at the 6-month and 12-month visits is used to track the process of each child that participates in the intervention.

Asthma counseling is the core component of the CHAMPS intervention. The asthma counselor educates patients and their families on asthma and teaches them how to manage the disease via proper medication use, behavior change, allergen avoidance, and environmental allergen mitigation. Asthma counseling is patient-tailored with each counseling session personalized to the patient’s allergic sensitivity, environmental exposures, disease knowledge, and current behaviors.

The asthma counselor uses the CHAMPS tools to learn about each patient’s unique experience with asthma, asthma management, allergic sensitivity, and environmental exposures and then provides a tailored counseling intervention.

The CHAMPS intervention consists of three basic components: 

1. Asthma and allergic sensitivity assessment. Learn more in the Allergen Sensitivity Testing section of the Manual.
2. Home environment assessment. Learn more in the Home Environment Assessment section of the Manual.
3. Patient-tailored asthma counseling. Learn more in the Tailoring the Intervention section of the Manual.

Asthma counselors may be responsible for some or all of these steps, depending on how your practice is organized.  Steps (1) and (2) provide the personalized, patient-specific information needed to craft a tailored intervention in step (3). 

Counseling is delivered via face-to-face interactions, either at the practice or in the patient’s home.  The counseling objectives and topics for each visit occur in a recommended order that is unique to the patient, based on his/her specific asthma risks, environmental exposures, and allergic sensitivities.  Counselors conduct a minimum of four counseling visits in the year-long CHAMPS intervention, but additional visits may be scheduled if a patient needs additional time to complete their specific counseling objectives.  Likewise, visits may continue beyond a year to help families achieve optimum control over the patient’s asthma.  No two patients are the same, and families will progress through the counseling components at different speeds and with varying degrees of success.     

The Conducting Asthma Counseling section of the Manual provides detailed instructions that cover all phases of the CHAMPS asthma counseling intervention. In addition to studying the CHAMPS materials provided on this site, we strongly recommend that asthma counselors seek external asthma education training and certification via the National Board for Respiratory Care. You can also learn more in this brief CHAMPS e-Learning video.