Keeping Airways Open

Putting the Guidelines

Implementation Panel Report 

in Motion

A Plan of Action for the National Asthma 

Control Initiative
Preface 4

Action Item 1: Convene leaders and 

stakeholders and energize them to become 

involved in NACI activities

11

Action Item 2: Develop a communication 

infrastructure to promote dialogue among 

stakeholders, give access to resources, and 

share information

12

Action Item 3: Encourage and support 

partnerships to enhance integration of clinical 

 and community-based interventions and 

strengthen sustainability

13

Action Item 4: Fund and support best practices 

and evidence-based demonstration projects

14

Action Item 5: Monitor and assess NACI 

progress by using outcome measures and 

sharing lessons learned

15
Putting the Guidelines

Implementation Panel Report 

in Motion

A Plan of Action for the National Asthma 

Control Initiative

http://naci.nhlbi.nih.gov

NIH Publication No. 10-7543

April 2010
4 Putting the Guidelines Implementation Panel Report in Motion

Preface

Inhaling and exhaling—most of us don’t give it a second thought.

For the 23 million Americans who have asthma,1 including some 6.7 million children,2 breathing isn’t quite so 

simple. This common chronic disease often impacts physical, psychological, and social wellbeing and quality 

of life. Moreover, the financial costs of asthma, particularly for uncontrolled and poorly controlled asthma, 

are substantial both for individuals and for society. Overall, the economic burden due to asthma, ranging 

from hospitalizations to lost wages, has been estimated to be as much as $19.7 billion.3

In Crossing the Quality Chasm (2001), the Institute of Medicine notes asthma as one of 15 “priority conditions” 

for which strategies, goals, and action plans should be developed to achieve substantial improvements in 

health care quality.4

Now, thanks to a new initiative formed to prompt action on using the latest evidence-based national 

guidelines for diagnosing and managing asthma, we have an opportunity to help people who have asthma 

breathe easier. 

You can make a difference in the lives of millions of Americans by joining forces 

in the new National Asthma Control Initiative (NACI). The NACI is an initiative 

of the National Asthma Education and Prevention Program (NAEPP), coordinated by the National Heart, Lung, and Blood Institute (NHLBI). NAEPP members 

include major scientific, professional, governmental, patient advocacy, and 

voluntary organizations working to enhance the quality of life for people with 

asthma and to decrease asthma-related morbidity and mortality. 

The NACI will bring together organizations from local, regional, and national 

levels to share best practices; leverage resources; identify new directions; 

create learning opportunities; and ultimately bring the asthma care that patients receive in line with 

NAEPP’s national clinical practice guidelines. 

This document outlines what action steps the NHLBI—as convener and as member of the NAEPP—is 

committed to undertaking in order to engage and stimulate further activity by partners and other stakeholders.

1. Pleis JR, Lucas JW. (2009). Summary health statistics for U.S. adults: National Health Interview Survey, 2007. National Center 

for Health Statistics. Vital Health Stat 10(240).

2. Bloom B, Cohen RA. (2009). Summary health statistics for U.S. children: National Health Interview Survey, 2007. National Center 

for Health Statistics. Vital Health Stat 10(239).

3. National Heart, Lung, and Blood Institute. (2007). Morbidity and Mortality: 2007 Chartbook of Cardiovascular, Lung and Blood 

Diseases. Bethesda, MD: U.S. Department of Health and Human Services.

4. Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: 

National Academies Press.
A Plan of Action for the National Asthma Control Initiative 5
6 Putting the Guidelines Implementation Panel Report in Motion

A Roadmap for Change

For the past 20 years, the NAEPP has been working with government and voluntary agencies, professional 

associations, patient advocacy groups, and many other organizations to develop national clinical practice 

guidelines and to educate patients, health professionals, and the public. 

To develop the guidelines, the NAEPP has convened expert panels to conduct a systematic review of the 

scientific evidence and provide recommendations for making appropriate clinical decisions about asthma 

care. The NAEPP released the latest panel report, Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis 

and Management of Asthma, in August 2007. It outlined four key components of asthma care, summarized 

briefly below.5

Component 1: Assessment and Monitoring. To diagnose and assess the characteristics and severity of 

asthma and to monitor whether asthma control is achieved and maintained.

Component 2: Education. To build a solid partnership for effective asthma self-management education 

among the patient, family/caregiver, and health care provider.

Component 3: Environmental Control. To implement multi-faceted strategies to control environmental 

factors and to treat comorbid conditions that affect asthma.

Component 4: Pharmacologic Therapy. To select the appropriate medications and to review the patient’s 

technique and adherence to meet the patient’s needs and circumstances.

Nevertheless, simply knowing 

the components of asthma 

management is not enough. 

The challenge is to create an 

effective plan of action that 

integrates them—a plan that will 

bridge the significant gap between 

treatments proven to work and 

the level of care that actually is 

being received by many asthma 

patients. For instance, although 

prescribing of appropriate 

asthma medications by physicians has increased,6

 many asthma patients do not take their medication 

or do not use it properly. Further, many patients and caregivers remain unaware of how to effectively 

manage asthma on a daily basis and how to respond to asthma attacks.7
A Plan of Action for the National Asthma Control Initiative 7

To help meet the challenge of fully implementing the guidelines, the NAEPP convened a diverse 17-member 

Guidelines Implementation Panel (GIP) and charged it with developing a report to enhance the implementation of the EPR-3 guidelines.8

 The GIP identified six priority, action-oriented messages within the four components of asthma care outlined above:

• Use Inhaled Corticosteroids (Component 4)

• Use Asthma Action Plans (Component 2)

• Assess Asthma Severity (Component 1)

• Assess Asthma Control (Component 1)

• Schedule Followup Visits (Component 1)

• Control Environmental Exposures (Component 3)

Within each of these six messages, the GIP Report grouped its 

recommendations and strategies around three core themes. The GIP 

identified these themes as being associated with successful health 

care interventions, and as providing a useful structure for organizing 

numerous GIP recommendations and strategies to support a 

nation-wide program for improving guidelines implementation. 

The three themes are:

1. Communication. Getting the messages out on a broad scale to all audiences, including patients and 

providers, in a variety of settings.

2. Systems Integration. Designing and coordinating messages for essential players up, down, and across 

the operational tiers of a health system as well as across multiple systems; and strengthening linkages 

between health and community systems.

3. Patient/Provider Support. Identifying the tools, techniques, and other resources that would enhance 

guidelines implementation.

The GIP Report envisioned three overarching implementation approaches, or “effector arms,” all 

simultaneously working to move the document from a static set of recommendations and strategies 

to a dynamic, integrative, and comprehensive mobilization effort. 

1. NAEPP Partnerships. Stimulate and coordinate NAEPP initiatives, partnerships, and collaborative 

activities to facilitate implementation of the GIP recommendations.

2. National Asthma Campaign. Develop, implement, and evaluate a coordinated national asthma 

campaign to cultivate new stakeholders and educate stakeholders about the six priority messages 

using NACI branded materials. 

3. National Asthma Policy Forum. Convene a national forum that would feature expertise in public health 

and health policy and promote the implementation of policies that advance the EPR-3 guidelines.
8 Putting the Guidelines Implementation Panel Report in Motion

The GIP Report gives guidance to all asthma stakeholders for taking action around the six priority 

messages. While the NAEPP coordinated the development of the GIP Report, the NAEPP, through its 

partnerships and collaborative activities, is only one of the three effector arms identified by the GIP 

Report to stimulate the implementation of its recommendations and strategies (see Figure 1). To this end, 

the NAEPP, supported by the NHLBI, is focused on enhancing partnerships and collaborative activities 

through a new initiative, the NACI, to fuel initial and sustainable momentum among asthma stakeholders 

for implementing the GIP Report. Although the NACI is focusing initially on the partnership effector arm, 

it will work collaboratively with other effector arms to enhance implementation of the six priority 

GIP messages. 

Figure 1: National Asthma Control Initiative Framework

NAEPP

EPR-3 

Guidelines

Six GIP Messages

1. Use inhaled corticosteroids

2. Use written asthma 

 action plans

3. Assess asthma severity

4. Assess and monitor 

 asthma control

5. Schedule followup visits

6. Control environmental 

 exposures

Implementation through 

broad-based stakeholder 

engagement

National Asthma 

Campaign

NAEPP/NACI 

Partnerships and 

Activities

National Asthma 

Policy Forum

NACI Action Items

GOAL

Improved asthma 

care, asthma 

control, and quality 

of life for all people 

with asthma Monitor and assess 

NACI progress toward 

its goals by measuring 

outcomes and sharing 

lessons learned

Convene and energize 

national, regional, state, 

and local leaders

Develop a communication 

infrastructure for information 

sharing and accessing 

resources

Mobilize champion 

networks to implement 

and integrate clinical 

and community-based 

interventions with 

emphasis on 

sustainability Demonstrate evidence-based 

and best practice approaches 

for specific audiences in 

various settings with 

emphasis on closing the 

asthma disparity gap

5. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. (2007). Expert Panel Report 3 (EPR3): 

Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: U.S. Department of Health and Human Services. 

6. National Committee for Quality Assurance. (2004). The State of Health Care Quality: Industry Trends and Analysis. Washington D.C.: National 

Committee for Quality Assurance.

7. Lara M, Rosenbaum S, Rachelefsky G, et al. (2002). Improving childhood asthma outcomes in the United States: a blueprint for policy action. 

Pediatrics, 109(5): 919-30. 

8. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. (2008). Guidelines Implementation 

Panel Report for Expert Panel Report 3 - Guidelines for the Diagnosis and Management of Asthma. Bethesda, MD: U.S. Department of Health 

and Human Services.
A Plan of Action for the National Asthma Control Initiative 9

The Highway Ahead 

The road to implementation may be long and winding, but over every hill and around every bend are 

incredible opportunities for collaboration and innovation. With the GIP’s guidance on how to implement 

the latest evidence-based guidelines, and the participation and assistance of multiple stakeholders 

in the NACI, we can overcome dynamic behavioral and systemic barriers. NHLBI is committed to five 

overarching action items based on the GIP Report to set the NACI in motion:

Action Item 1. Convene leaders and stakeholders and energize them to become involved in NACI activities.

Action Item 2. Develop a communication infrastructure to promote dialogue among stakeholders, give 

access to resources, and share information.

Action Item 3. Encourage and support partnerships to enhance integration of clinical and community-based 

interventions and strengthen sustainability.

Action Item 4. Fund and support best practices and evidence-based demonstration projects.

Action Item 5. Monitor and assess NACI progress by using outcome measures and sharing lessons learned.

The NACI Plan of Action is a framework to be used in tandem with the GIP Report, which offers more detailed 

recommendations and strategies for activities and interventions to improve asthma control. Moreover, it is 

designed to be a living document; as progress is made or issues emerge, the NACI will modify its approaches 

accordingly.

Although one agency cannot possibly address all of the recommendations and strategies outlined in the 

GIP Report or in this Plan of Action, the NHLBI is committed to providing a launching pad and several focused 

activities to build momentum for the NACI. However, it will take the involvement of many stakeholders 

across the asthma community and beyond to reach the objectives presented in the GIP Report. NHLBI invites 

organizations and individuals to join in these initial 

activities, and to take on other recommendations 

and strategies outlined in the GIP Report. It is through 

such collaborative and synergistic linkages that 

the NACI hopes to foster increased adoption of the 

evidence-based best practices reflected in the six 

priority GIP messages.
10 Putting the Guidelines Implementation Panel Report in Motion
A Plan of Action for the National Asthma Control Initiative 11

Action Item 1: 

Convene leaders and stakeholders and energize them to become 

involved in NACI activities.

The GIP Report calls for stakeholders at all levels to “get involved” with implementing six priority messages 

derived from the EPR-3 Guidelines. Multi-sector stakeholder activities can bring about high-impact solutions 

and meaningful change across the spectrum of issues and barriers that impede effective asthma control. 

The NACI will engage NAEPP Coordinating Committee members and other traditional stakeholders and will 

recruit new partners to be “conveyors” and “navigators” of the GIP messages. This expanded and energized 

partnership of asthma champions will promote enhanced communication about the messages, integrate 

the messages into health systems, and increase awareness about supportive tools and materials available 

to enhance patient/family and provider behavior to improve asthma control. The enthusiasm and energy 

of the asthma community is high; the NACI will build on this to create a movement around the GIP messages 

as a significant means of improving asthma control.

Activities:

• Identify and recruit partners from diverse sectors 

and disciplines who have the ability to make 

an impact on implementation barriers and who 

have access to and influence target audiences. 

Examples of sectors to engage include:

- Government agencies

- Professional associations

- Patient advocacy groups

- Academic institutions

- Asthma coalitions

- Media 

- Employers 

- Schools and childcare centers

- Clinical systems of care, including 

hospitals, health plans, and community 

health centers

- Payors

- Medical/nursing training programs

- Faith-based organizations

• Engage partners in direct dialogue around important 

NACI issues (e.g., patient self-management, care 

coordination, quality improvement, reimbursement, 

health benefits, public health policies) to facilitate 

partner engagement. 

- Identify common and complementary interests 

and capabilities.

- Further define partner roles and what each 

partner will do to support the work of the NACI.

• Bring partners together to share lessons, mobilize 

resources to respond to issues of mutual concern, 

and create and maintain widespread support for 

the GIP priorities. 

• Develop a unifying logo and tagline to promote 

a pervasive awareness of the scope of the 

NACI and emphasize its value among multiple 

stakeholders.

• Develop tools and materials to aid in building 

support for the NACI, such as slide show 

templates and fact sheets about the initiative.
12 Putting the Guidelines Implementation Panel Report in Motion

Action Item 2: 

Develop a communication infrastructure to promote dialogue among 

stakeholders, give access to resources, and share information.

It will be essential to establish a communication infrastructure that can accommodate the diverse needs 

of NACI partners and stakeholders and enhance communication with patients and the public. A planned, 

coordinated infrastructure will help to develop and foster collaboration and information sharing among 

partners, and to monitor progress on the various GIP implementation-related activities. In developing 

a communication infrastructure, when possible, the NACI will work within existing communication 

networks to minimize duplication of efforts and to maximize reach.

Activities:

• Develop a Web site. An Internet presence for 

the NACI is vital to keep stakeholders abreast 

of NACI activities and engaged in the 

initiative. The Web site will serve to facilitate 

communication among partners involved 

in asthma activities who may have limited 

opportunities or forums in which to discuss 

their efforts, to collect information from NACI 

participants about their activities, and to house 

and distribute information and tools identified 

and/or developed by NACI stakeholders. 

• Facilitate the development of “communities 

of practice” organized around GIP messages, 

target audiences, or program settings. 

Communities of practice may be formal 

subcommittees of the NAEPP Coordinating 

Committee, or they may be informal groups 

that network primarily online and through 

e-mail listservs. Moreover, some groups may 

be “seeded” by the NACI, while others will 

develop organically. Whatever the case, 

it is expected that these groups will make the 

full use of online and offline networking tools 

to share information and resources, promote 

collaboration around issues of mutual interest, 

and identify gaps in the implementation 

of the GIP recommendations. 
A Plan of Action for the National Asthma Control Initiative 13

Action Item 3: 

Encourage and support partnerships to enhance integration of clinical 

and community-based interventions and strengthen sustainability.

Interventions promoted by the NACI should be guidelines-based and intended to promote changes in 

patient and/or provider behavior and in health care systems to enhance quality of care, improve outcomes, 

and reduce health disparities. At every level of intervention, the key to mobilizing support around this issue 

will be the recruitment and establishment of asthma champions who are committed to improving care, 

promoting the EPR-3 guidelines in their workplaces and communities, and fostering collaboration between 

clinical and community care structures. 

Among the many places that champions can implement clinical and community-based interventions 

are rural and urban areas, medical and nursing schools, medical practices, workplaces, insurance 

and benefits companies, school systems, state and local public health departments, asthma coalitions, 

and community - and faith-based organizations. 

Activities:

• Identify and recruit partners from diverse sectors 

and disciplines who have the ability to make an 

impact on implementation barriers and who have 

access to and influence target audiences. Examples 

of ways that champions can access and influence 

target audiences include:

- Support the adoption of GIP recommendations 

and strategies by offering a menu of resources 

and interventions that could be implemented 

by champions in diverse settings, including 

clinical and community environments.

- Use lessons learned and tested tools from 

quality improvement strategies and pointof-service prompting (e.g., electronic health 

records, pay for performance, standing orders, 

provider feedback, and plan-level quality 

measures) to enable improvements in clinical 

and public health practices.

- Work with partners to develop online asthma 

management tools that could be used in existing medical information systems. Such tools 

would improve the tracking of asthma 

 management efforts while facilitating 

integration of activities among various levels 

of the care system (providers, patients and 

families, schools, communities).

- Adopt or develop NACI-branded tools and 

resources for use by champions, health care 

providers, patients, and their families. 

- Develop approaches (including case 

management programs) that promote patient 

self-management skills and provider 

communication techniques that are culturally 

relevant, easily understood and accepted 

by patients and their families.

• Encourage champions to document the scope, 

reach, and impact of their programs and to share 

this information through the NACI. In addition, 

champions will be encouraged to exchange tools, 

materials, and other best practice approaches.

• Build programs and interventions in ways that 

will sustain the involvement of asthma champions 

and other stakeholders.
14 Putting the Guidelines Implementation Panel Report in Motion

Action Item 4: 

Fund and support best practices and evidence-based demonstration 

projects.

The NHLBI will stimulate the implementation of the demonstration projects funded by competitively 

awarded contracts to serve as testing grounds for further exploration and real-world insight into 

promising practices to enhance asthma control. Applications will be sought from institutions looking 

to promote GIP messages in new ways, as well as institutions taking proven interventions into new 

communities or settings. Funded demonstration projects will comprise one tier of partners integral 

to the composition of the NACI.

Activities:

• Establish an “Enhanced Application Projects” 

contract program to support NACI 

demonstration projects. The purpose of this 

program is to promote the implementation 

and dissemination of science-based asthma 

strategies and interventions.

• Solicit proposals that address one or more 

of the six GIP messages, focusing on the target 

audiences and strategies appropriate to the 

applicant institution. 

• Issue awards to fund selected demonstration 

projects.

• Track and assess project implementation 

through the collection and analysis of process 

and outcomes data.

• Use the national communication infrastructure 

to disseminate lessons learned and findings 

from the demonstration projects during and 

after implementation.
A Plan of Action for the National Asthma Control Initiative 15

Action Item 5: 

Monitor and assess NACI progress by using outcome measures and 

sharing lessons learned.

Evaluation of NACI activities will strive to balance the need to be rigorous with the need to be realistic and 

practical and will use appropriate methods to ensure meaningful and defensible results. Evaluation should 

also consider contextual factors that may influence the success of particular implementation strategies. 

Assessment and measurement will be designed to:

• Improve program implementation—to provide quality data that will help the NHLBI and its partners to 

continually improve the program 

• Capture lessons learned—to use for future scale-up of program components 

• Demonstrate successes—to highlight the reach, output, and impact of the program to key constituencies

Activities:

• Develop a logic model to articulate the overall 

goals and objectives of the NACI as well as 

describe individual program activities with 

expected outputs and outcomes.

• Engage stakeholders in the evaluation process 

and frame evaluation questions to be of use 

to stakeholders.

• Focus the evaluation design to employ an 

appropriate choice of practical evaluation 

methods that address the key research questions 

while being mindful of the audience and setting 

under examination. For example, research 

questions may assess how NACI resources are 

being used globally, and how they may look at 

specific components of the NACI, such as the

reach and impact of NACI demonstration projects, 

strategic partnerships or the champions program:

- Monitor demonstration projects by periodically 

gathering process and outcomes data and 

using this information to highlight successes 

and help improve projects.

- Consider ways to integrate common measures 

that would allow for pooling of data across 

interventions. 

- Convene a group to inform data analysis, 

reporting and dissemination plans.
 

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NIH Publication No. 10-7543 

April 2010