Transcript Organizational Issues in Asthma Care: Outcomes and

NATIONAL EXAM
CERTIFICATION
for Certified Asthma
Educators (AE-C)
Presented by:
Kathleen Moseley RN MS AE-C
Tips for studying for the Exam
1.) Organize material into topics
2.) Set up a study schedule, e.g. , 4
week, 6 week or 8 week plan
3.) Identify your weak areas and strong
areas, studying the strong ones last
Information to Memorize
• Severity tables, start with the far left column,
then middle column, then remaining. Middle age
first
• Control tables
• List of Medications-Inhaled Steroids,
Leukotriene modifiers, etc… use flashcards if
helpful, Mother’s of Asthmatics poster
Information to Memorize
•
•
•
•
•
Stepwise Diagram-treatment table
Drug-Drug Interactions
Safe Drugs during pregnancy
Herbal Supplement Interactions
Referral Criteria for specialist
Information to Memorize
•Calculating and reading Spirometry
Results
•Co-morbid conditions
•Asthma Predictive Index
Reading Exam Items
1.)Question
2.)Options or distracters
3.)Key or answer
Reading the Exam Question
• The introductory statement-the scenario
• The Stem-poses the question
• The options; the key and distracters
Anatomy of an Exam Item
Each item has three main parts:
The stem
The key
A set of
distracters
Anatomy of an Exam Item
Stem: Statement or question to which candidate
responds (may be an incomplete sentence).
The amount of detail depends on the cognitive
level of the item.
Anatomy of an Exam Item
Key: The right answer as defined by the
committee and content experts.
In some cases the key will the BEST answer.
Other choices may also be correct, but they would
not be the first thing to do or they would not be the
best choice for the situation presented.
Anatomy of an Exam Item
Distracters: Wrong answers that are meant to be
plausible but wrong and will distinguish able
candidates from weak candidates.
Anatomy of an Exam Item
There are 3 forms of questions defined by the
“cognitive level”:
1. Recall
2. Application
3. Analysis
Anatomy of an Exam Item
Recall items: Typically depend on rote memorization
and the answer is true for all situations (19%).
EXAMPLE: A useful tool for a person with asthma to
assess their asthma control is a:
A. Small-volume spacer
B. Spirometer
C. Pulse oximeter
D. Peak flow meter
Anatomy of an Exam Item
Application items: More situation-dependent or
involve some calculation or manipulation of
information (44%).
EXAMPLE: A 40-year old male presents to the
primary care doctor with wheezing, cough and
shortness of breath after exercise. Which of the
following best describes these symptoms?
A.
B.
C.
D.
Bronchospasm
Airway inflammation
Mucous production
Foreign body aspiration
Anatomy of an Exam Item
Analysis items: More complex item usually presenting three
or more pieces of info. Often focus on what asthma
educators should do rather than just what they should know
(37%).
EXAMPLE: A person with dust mite sensitivity has been using
a LTC med (compliance, technique are not issues). The
individual’s symptoms persist. Which of the following should
an asthma educator verify?
A. Use of a HEPA filter in the living room
B. Installment of a room ionizer
C. Encasement of individual’s mattress and pillow
D. Installment of new carpet in the bedroom
Test-Taking Tips
• Read everything carefully.
• Don’t second-guess yourself.
• Put questions in context with things that are familiar
to you.
• Remind yourself that you have the benefits of
experience and knowledge.
• Use the process of elimination (POE) on difficult
questions.
• Manage your energy level.
• Use the scrap paper provided.
Use POE on Questions You Find Difficult
• Every time you eliminate an incorrect choice on
a question, you improve your odds of finding the
best answer.
• The more incorrect choices you eliminate, the
better your odds.
Energy Management
• It is often difficult, psychologically, to let go of a
problem once you have spent time on it. The
more time you invest, the harder it is to let go.
• Learn when it’s time to guess and move on to
other questions on which your energy (and
perhaps time) will be better spent.
Scratch Paper, Computerized Testing & POE
• For POE to work, its crucial to keep track of
choices you eliminate. By crossing out a clearly
incorrect answer, you permanently eliminate it
from consideration.
• If you don’t cross it out, you may continually
consider it or be distracted by it.
• But how do you cross out anything on a
computer screen?
Scratch Paper
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
Bookmarking
IMPORTANT: If an item is left
bookmarked, it is not counted, even
if the correct answer is checked.
Case Study #1: Exaggerated Case Study
Fred is a 56-year-old African American male with a
history of asthma. He presents today, with his wife
at his side, reporting daily daytime symptoms and
frequent nighttime symptoms. He said this is an
increase from his usual symptoms, which were
reported to occur daily more than 2/week but less
than 1/day and nighttime 2 nights/month.
Fred says he and his wife are having marital
problems related to her refusal to remove her cat
(one of his triggers) from their bedroom. His job is
being restructured and he feels his position may
be cut. His 16-year-old daughter recently moved
back into the home with her 1-½ year old child and
a dog.
Fred’s current signs and symptoms include at FEV1
80%, pulse 80 and a respiratory rate of 18/minute.
His current meds include a rescue inhaler with
spacer.
Your Best Action(s) Would Be:
A. Ask Fred how often he checks his peak-flow
meter.
B. Have Fred demonstrate the use of an MDI with
a spacer.
C. Set Fred up with a job skills class.
D. Suggest to the physician that Fred needs a
long acting corticosteroid.
Sample Question #1
An adolescent male with moderate persistent asthma tells his
asthma educator that his current medications are not controlling his
symptoms. He is using pirbuterol four times daily using a valved
holding chamber, but stopped using budesonide because he did not
any feel better after using it. Which of the following actions by the
asthma educator would be most likely to improve his asthma control
over the short term?
A. Verify the adequacy of his inhaler technique with a valved
holding chamber.
B. Recommend changing budesonide to a different
medication.
C. Discuss the differences between the use of quick relief
and controller medications.
D. Advise him regarding environmental modifications to
avoid asthma triggers.
NAECB Candidate Handbook, 2007
• This came from the candidate handbook – it’s an
example of an Analysis question
• answer: C
Sample Question #2:
For the best effect, adults with asthma should use
nedocromil:
A. two to four times per day until discontinued by the
asthma care provider
B. once daily in the morning until the asthma
exacerbation has resolved.
C. for quick relief of exercise induced asthma symptoms.
D. daily at bedtime to prevent nocturnal asthma
symptoms.
NAECB Candidate Handbook, 2007
“Nedocromil oral inhalation U.S. after June 14,
2010. If you are currently using nedocromil, you
should call your doctor to discuss switching to
another treatment”
Old question, but you can see that it is a recall
question using medication names.
This is from the Candidate handbook – it’s an
example of a Recall question about medication
dosages
answer: A
Sample Question #3:
Which of the following would be the best method for an
asthma educator to assist an adolescent boy to integrate
his asthma action plan into his normal routine? The asthma
educator should:
A. Give him a written action plan listing medication times to post in
his bedroom.
B. Suggest he check peak flow readings around activities he does
most days.
C. Encourage him to use the inhaled corticosteroid before
brushing his teeth.
D. Recommend completing his symptom diary before going to bed
each night.
NAECB Candidate Handbook, 2007
Answer
• This is from the candidate handbook – it’s an
example of an Application question
• Answer: B one that best implies an assessment
of his activities
Preparing for the Exam
Days/weeks before:
• Apply for the exam (www.naecb.org).
• Schedule a testing appointment (application valid
for 1 year).
• Review and prepare.
• Take a practice test on web. (www.naecb.org)
• Find test site (H&R Block), look for parking etc.
Preparing for the Exam
Night/morning before:
• Make a final review of the materials.
• Get plenty of rest.
• Eat breakfast.
• Arrive early (no admittance if you are more than
15 minutes late).
• Have ID ready – 2 forms, one with photo.
• Don’t take anything else to testing center.
During the Exam
You have 3.5 hours; there are 175 questions.
You can monitor your time on the computer.
You can move back and forth between questions.
You can change your answers.
You can bookmark an item for review.
During the Exam
You will be provided with scratch paper, which
must be returned at the end of the test.
No questions may be asked during the test.
No eating, drinking or smoking.
You may take a break, but break time counts
toward your 3.5-hour limit.
Test-Taking Tips
•
•
•
•
Enter the exam rested and ready to think.
Read the instructions and questions carefully.
Don’t second-guess yourself.
Put questions in context with things that are
familiar to you.
• Remind yourself that you have experience and
knowledge to help you. Think positively!
After the Exam
• Congratulate yourself on giving it your best effort!
• Please contact us with feedback.
– What did you think of the test?
– How well did this course help you prepare?
– What could we have done to make the course more
helpful?
– How did you do on the test?
CPT Codes and Reimbursement
• 2006 CPT codebook includes:
– 98960 Education and training for patient selfmanagement by a qualified, non-physician healthcare
professional using a standardized curriculum, face-toface with the patient (could include caregiver/family)
each 30 minutes, individual patient
– 98961 2-4 patients
– 98962 5-8 patients
CPT Codes and Reimbursement
• Purpose of these codes is to teach selfmanagement of a patient’s illness or disease or
delay disease co-morbidity.
• Curriculum used in patient education must be
recognized by a physician society or by a nonphysician healthcare professional
society/association.
CPT Codes and Reimbursement
• It is unclear at this point how the codes will be
used and what the specific reimbursement will
be.
• Submission of these codes on a regular basis
will help more third-party payers accept and
reimburse using these new codes.
Your Asthma Educator Institute Faculty
Acknowledgements
• David DeBiasi
American Lung Association in Virginia
• Michelle Mercure, CHES
American Lung Association in Wisconsin
We will breathe easier when the air in every
American community is clean and healthy.
We will breathe easier when people are free from the addictive
grip of cigarettes and the debilitating effects of lung disease.
We will breathe easier when the air in our public spaces and
workplaces is clear of secondhand smoke.
We will breathe easier when children no longer
battle airborne poisons or fear an asthma attack.
Until then, we are fighting for air.