Electronic Asthma Action Plans: Provider Survey Question Title * 1. Have you ever used an electronic Asthma Action Plan developed by the Asthma Initiative of Michigan (AIM)? Yes, currently using Yes, previously used No, using one not developed by AIM No, not currently using an asthma action plan OK Question Title * 2. Was the asthma action plan provided by AIM easy to use? Yes No Not using AIM action plan OK Question Title * 3. Please provide feedback on ease of use: OK Question Title * 4. On average, how long do you spend filling out an electronic Asthma Action Plan? 0-5 minutes 5-7 minutes 7-10 minutes 10-15 minutes 15 or more minutes OK Question Title * 5. Which best describes how often you use/update electronic Asthma Action Plans with patients? At each visit Only when primary reason for visit is asthma related When asked by patient/parent Do not use Asthma Action Plans OK Question Title * 6. Do you provide a copy of the asthma action plan to patients? Yes, paper/printed copy Yes, electronic copy via patient portal No, do not provide patient a copy Not currently using asthma action plans with patients OK Question Title * 7. Do you find [these or other] electronic Asthma Action Plans to be a beneficial communication tool to use with patients, parents, other providers, and schools/daycares for asthma management? Yes No Neutral OK Question Title * 8. Do you believe patients/parents find Asthma Action Plans useful for asthma management? Yes No OK Question Title * 9. Please share suggestions or modification that you believe would improve the AIM electronic Asthma Action Plans. OK Question Title * 10. When educating patients/parents using Asthma Action Plans, are you also providing education regarding use of spacers/valved holding chambers (VHC)? Yes No OK Question Title * 11. If no, would you like to receive spacer/VHC access/use information to distribute to patients? Yes No OK Question Title * 12. Do you refer patients to home-based asthma management programs? Yes No OK Question Title * 13. If yes, which ones? OK Question Title * 14. If no, would you like more information on home-based asthma management programs in your area? Yes No OK Question Title * 15. Contact Information: Name Company City/Town Email Address Phone Number OK Question Title * 16. Do you have any additional comments? Yes No OK NEXT