{"id":75382,"date":"2025-02-25T16:12:31","date_gmt":"2025-02-26T00:12:31","guid":{"rendered":"https:\/\/www.qualityhealth.org\/bree\/?page_id=75382"},"modified":"2026-04-05T20:50:51","modified_gmt":"2026-04-06T03:50:51","slug":"general","status":"publish","type":"page","link":"https:\/\/www.qualityhealth.org\/bree\/general\/","title":{"rendered":"General"},"content":{"rendered":"

[vc_row overlay_dotted=”” el_id=”general-guidelines-row”][vc_column][vc_tta_tour style=”outline” shape=”square” color=”black” spacing=”20″ active_section=”1″ no_fill_content_area=”true” el_id=”LGBTQ-care-tour” title=”Health Impacts of Extreme Heat and Wildfire Smoke – NEW!”][vc_tta_section title=”Guideline Information” tab_id=”1682016949037-75908d8f-f436″][vc_column_text css=””]<\/p>\n

Guideline title: Health Impacts of Extreme Heat and Wildfire Smoke<\/h4>\n

Publication Status: <\/strong>January 2025
\n<\/strong><\/p>\n

Date of publication<\/strong>: 2025<\/p>\n

Date of last evidence search: <\/strong>2024<\/p>\n

Scope: <\/strong>TBD<\/span>
\n<\/span><\/span><\/p>\n

Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n

Description: <\/strong>This report\u2019s main aim is to reduce morbidity and mortality related to extreme heat and wildfire smoke. Heat-related illnesses and health impacts due to poor air quality can be prevented or reduced by implementing evidence-informed, coordinated efforts across sectors, such as early detection and warning systems, education and communication, and standardized protocols for responding to heat- related illnesses and exacerbation. Addressing the underlying social and environmental determinants of health that make certain populations more vulnerable to heat and wildfire smoke can reduce disparities and promote health equity in the face of our changing climate.<\/span><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Read On-line” tab_id=”1682016949524-967ecade-ea17″][vc_column_text css=””]<\/p>\n

Read our Report<\/a><\/h3>\n

[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Implementation Checklist by Audience” tab_id=”1738693408883-638eff4c-6fcb”][vc_toggle title=”Healthcare Professional” css=””]Level 1<\/a><\/p>\n

Level 2<\/a><\/p>\n

Level 3<\/a>[\/vc_toggle][vc_toggle title=”Health Plan” css=””]Level 1<\/a><\/p>\n

Level 2<\/a><\/p>\n

Level 3<\/a>[\/vc_toggle][vc_toggle title=”Outpatient Clinic Healthcare Staff” css=””]Level 1<\/a><\/p>\n

Level 2<\/a><\/p>\n

Level 3[\/vc_toggle][\/vc_tta_section][vc_tta_section title=”Resources and Tools” tab_id=”1682016959438-5ce8f90c-6fc1″][vc_toggle title=”Resources and Tools” css=””]AirNow<\/a><\/p>\n

CHILL\u2019D OUT Questionnaire<\/a><\/p>\n

Criteria for a Recommended Standard\u00a0 on Occupational Exposure to Heat and Hot Environments\u00a0<\/a><\/p>\n

Cool Neighborhoods NYC<\/a><\/p>\n

How to use the Heat Risk Tool and Air Quality Index\u00a0<\/a><\/p>\n

NWS HeatRisk<\/a><\/p>\n

Quick Start Guide for Clinicians on Heat and Health<\/a><\/p>\n

WA Air Quality Map<\/a><\/p>\n

WA Children & Youth Activities Guide for Air Quality<\/a><\/p>\n

WA DOH Portable Air Cleanser<\/a><\/p>\n

WA Health Alert Network<\/a><\/p>\n

WA Smoke Blog<\/a>[\/vc_toggle][vc_toggle title=”Resources and Tools for Clinicians” css=””]CLINICAL GUIDANCE\u00a0<\/strong><\/p>\n

CHILL\u2019D OUT Questionnaire<\/a><\/p>\n

Quick Start Guide for Clinicians on Heat and Health<\/a><\/p>\n

Heat and Medications \u2013 Guidance for Clinicians<\/a><\/p>\n

How to use the Heat Risk Tool and Air Quality Index\u00a0<\/a><\/p>\n

WA Children & Youth Activities Guide for Air Quality<\/a><\/p>\n

CLINICAL OVERVIEW<\/strong><\/p>\n

Heat and Health<\/a><\/p>\n

Heat and Cardiovascular Disease<\/a><\/p>\n

Heat and Children and Teens with Asthma<\/a><\/p>\n

Heat and Pregnancy<\/a><\/p>\n

PATIENT TOOLKITS\u00a0<\/strong><\/p>\n

For Caregivers of Children with Asthma\u00a0<\/a><\/p>\n

For Teens with Asthma<\/a><\/p>\n

For People with Heart Disease<\/a><\/p>\n

For Pregnant People<\/a><\/p>\n

OTHER RESOURCES<\/strong><\/p>\n

WA Air Quality Map<\/a><\/p>\n

WA DOH Portable Air Cleanser<\/a><\/p>\n

WA Health Alert Network<\/a><\/p>\n

WA Smoke Blog<\/a><\/p>\n

Wildfire Smoke Action Plan Template<\/a>[\/vc_toggle][vc_toggle title=”Evaluation Tools”]Toggle content goes here, click edit button to change this text.[\/vc_toggle][\/vc_tta_section][vc_tta_section title=”Toolkit” tab_id=”1756306464926-b5846c1e-3bdc”][vc_column_text css=””]<\/p>\n

Heat and Wildfire Smoke Toolkit for Professionals\u00a0<\/a><\/h3>\n

[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Metrics and Evaluation Tools” tab_id=”1682016974009-91adc275-63e1″][vc_column_text css=””]<\/p>\n

Introduction to Evaluation Tools<\/h4>\n

The Bree has developed multiple tools specific to the Health Impacts of Extreme Heat and Wildfire Smoke report, to support the evaluation projects implemented based on our guidelines.<\/p>\n

Evaluation Matrix<\/h4>\n

The Bree has developed an evaluation matrix to help clarify measurable objectives, goals, and metrics that are relevant to the recommendations made by the work group. The matrix can be use during planning of your implementation project to help identify long-term outcomes or impacts of your project(s). The matrix provides a broad summary of the recommendations by audience for each component or focus area the guideline addresses (for example: education, access, treatment, etc.).<\/p>\n

EVALUATION MATRIX<\/a><\/p>\n

Evaluation Framework<\/h4>\n

The Evaluation Framework provides further guidance on how organizations can conduct and align their work with other audience actors (example: all health plans in Washington state) or other audience types (example: health plans and providers). It provides specific details for measurement, provides strong and soft recommendations for the types of evaluations each organization may consider conducting, expands on alignment with other initiatives in Washington State, and makes recommendations for ethical and equity considerations.<\/p>\n

EVALUATION FRAMEWORK<\/a><\/p>\n

Data Matrix<\/h4>\n

An example of how to fill out this form is available in Appendix B of the Evaluation Framework. The Data Matrix tool can be used in planning your data collection effort for your implementation and evaluation.<\/p>\n

Data Matrix Template<\/a>– fillable form<\/p>\n

Theory of Change<\/h4>\n

The theory of change illustrates how the work group conceptualized changes that would occur throughout the health care ecosystem as a result of their recommendations. The subcommittee for this report has not yet developed a theory of change.<\/p>\n

THEORY OF CHANGE – (will be posted when complete)<\/p>\n

Score cards<\/h4>\n

To support health system improvement the Bree Collaborative has created evaluation score cards that are designed to help measure progress on the implementation of our guidelines.These measures were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n

To use our score cards, find the audience type, or types, that is closest to your organization and download the excel document. There may be more than one audience type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n

Score cards are also aligned with the Bree Collaborative’s self-report data collection efforts. Organizations are not required to report, however organizations can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p>\n

Completed score cards can be sent to knicholas@qualityhealth.org<\/a><\/p>\n

Score cards can be found in the tabs below:[\/vc_column_text][vc_toggle title=”Delivery Site and Health System” css=””]Health System Administration Score Card<\/a> (GIS version)<\/p>\n

Urgent Care Score Card<\/a> (GIS version)<\/p>\n

Hospitals and ERs Score Card<\/a> (GIS version)[\/vc_toggle][vc_toggle title=”Health Care Professionals” css=””]Clinician Score Card<\/a> (GIS Version)<\/p>\n

Outpatient Staff Score Card<\/a> (GIS Version)[\/vc_toggle][vc_toggle title=”Health Plans” css=””]Health Plan Score Card\u00a0<\/a> (GIS Version)[\/vc_toggle][vc_toggle title=”Washington State Agencies” css=””]Washington State Health Care Authority Score Card<\/p>\n

Washington State Department of Health Score Card<\/a> (GIS version)<\/p>\n

Washington State Department of Labor and Industries Score Card<\/a> (GIS version)<\/p>\n

Washington State DSHS Score Card<\/a> (GIS version)[\/vc_toggle][vc_toggle title=”Private and Public Purchasers” css=””]Employer\/Purchaser Score Cards<\/a> (GIS Version)[\/vc_toggle][vc_toggle title=”Community Based Organizations, Other (schools, LHJ’s etc.)” css=””]School Score Cards<\/a> (GIS version)<\/p>\n

Local Health Jurisdictions Score Cards<\/a> (GIS version)<\/p>\n

Long Term Care Organizations Score Cards<\/a> (GIS version)<\/p>\n

Emergency Medical Services<\/a> (GIS version)<\/p>\n

Other Community Based Organizations<\/a> (GIS version)[\/vc_toggle][vc_column_text]For more generic tools for planing, data collection and data management, please visit our Tool Depot[\/vc_column_text][vc_btn title=”Jump to Evaluation Tool Depot” color=”blue” link=”url:https%3A%2F%2Fwww.qualityhealth.org%2Fbree%2Fevaluation%2Fevaluation-tool-depot%2F|||”][\/vc_tta_section][vc_tta_section title=”Examples of Implementation – NEW!” tab_id=”1682017018966-9788a136-203d”][vc_column_text css=””]<\/p>\n

NEW! Thurston Climate Action Team (TCAT) – Heat Pump Distribution to Low Income Residence in Thurston County<\/h3>\n

In 2025, TCAT began a project to distribute heat pumps to low income residence of Thurston County. During the development phase of their work they were connected with the Bree Collaborative through their local health jurisdiction. Although the project was already being developed, TCAT was able to reference the Bree Guidelines as they built out their educational materials and partnered with the Bree to help them develop the evaluation of their project.<\/p>\n

Bree staff worked with TCAT staff to develop a Theory of Change<\/a> <\/strong>for their project and to identify measure aligned with the Bree recommendations.<\/p>\n

A one-page summary<\/a> <\/strong>of this project is available and final results of the project impact will be available in the Spring of 2026.[\/vc_column_text][vc_column_text css=””]<\/p>\n

NEW! ED and Outpatient Visits for Kids with Asthma: Observations during wildfire smoke episode in September of 2025<\/h3>\n

In 2024 Confluence Health participated in the Bree Collaborative’s Health Equity Action Collaborative. The project that they developed to address health disparities among Hispanic children resulted in the adoption and implementation of the Bree guidelines on the Health Impacts of Extreme Heat and Wildfire Smoke and Pediatric Asthma. Initial data from this project showed reductions in overall ED visits for children with Asthma and reductions in disparities between Hispanic and non-Hispanic children during the September 2025 wildfire smoke event.<\/p>\n

View the one-page summary<\/a> of how they leveraged Bree Resources to support their project.<\/p>\n

You can read their presentation to their quality improvement team HERE<\/a>.<\/p>\n

Get a copy of the Wildfire Smoke Action Plan<\/a>.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”WorkGroup Members” tab_id=”1739398229719-2c8d6c79-ee2b”][vc_column_text css=””]<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Name<\/strong><\/td>\nTitle<\/strong><\/td>\nOrganization<\/strong><\/td>\n<\/tr>\n
Chris Chen, MD (Chair)<\/td>\nMedical Director for Medicaid<\/td>\nWashington HealthCare Authority<\/td>\n<\/tr>\n<\/tbody>\n
Brad Kramer, PhD<\/td>\nProgram Manager<\/td>\nPublic Health Seattle King County<\/td>\n<\/tr>\n
Kristina Petsas, MD<\/td>\nChief Medical Officer for Employer and Individual Plans<\/td>\nUnited Healthcare<\/td>\n<\/tr>\n
Bre Holt<\/td>\nSenior Director Population Health<\/td>\nComagine Health<\/td>\n<\/tr>\n
Jessi Kelley<\/td>\nResearch Coordinator<\/td>\nUW Collaborative for Extreme Event Resilience<\/td>\n<\/tr>\n
Stefan Wheat, MD<\/td>\nEmergency Medicine Physician<\/td>\nUW<\/td>\n<\/tr>\n
Raj Sundar, MD<\/td>\nFamily Medicine Physician<\/td>\nKaiser Permanente<\/td>\n<\/tr>\n
Jessica Symank\/Amy Anderson<\/td>\nSenior Director, Safety Quality and Rural Programs<\/td>\nWashington State Hospital Association<\/td>\n<\/tr>\n
Kelly Naismith, MPH<\/td>\nClimate Change and Health Epidemiologist Supervisor<\/td>\nWashington Department of Health<\/td>\n<\/tr>\n
LuAnn Chen, MD, MHS<\/td>\nMedical Director<\/td>\nCommunity Health Plan of Washington<\/td>\n<\/tr>\n
June Spector, MD, MPH<\/td>\nInternal Medicine Physician\/Scientist<\/td>\nWashington Labor & Industries<\/td>\n<\/tr>\n
Mary Beth Bennett, MD<\/td>\nPediatric Resident<\/td>\nSeattle Children\u2019s<\/td>\n<\/tr>\n
Seth Doyle, MA<\/td>\nDirector of Strategic Initiatives\/President of WAPH<\/td>\nNorthwest Regional Primary Care Association\/Washington Association for Public Health<\/td>\n<\/tr>\n
Raymond Moeller, MD<\/td>\n<\/td>\nThurston County Medical Reserve Corps<\/td>\n<\/tr>\n<\/tbody>\n
Brian Henning, MD<\/td>\nDirector<\/td>\nGonzaga Institute for Climate, Water, and the Environment<\/td>\n<\/tr>\n
Onora Lien<\/td>\nExecutive Director<\/td>\nNorthwest Healthcare Response Network<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Archived Meeting Materials” tab_id=”1740174760591-a7f426b2-704d”][vc_column_text css=””]<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Date<\/strong><\/td>\nMaterials<\/strong><\/td>\n<\/tr>\n
January 10th, 2024<\/td>\n\n

January Agenda<\/a><\/p>\n

Draft Charter and Roster<\/a><\/td>\n<\/tr>\n

February 14th<\/td>\nFebruary Agenda<\/a>
\nJanuary Minutes<\/a>
\nDraft Focus Areas<\/a><\/td>\n<\/tr>\n
March 13th<\/td>\nMarch Agenda<\/a>
\nFebruary Minutes<\/a>
\nDraft Focus Areas<\/a><\/td>\n<\/tr>\n
April 10th<\/td>\nApril Agenda<\/a>
\nMarch Minutes<\/a>
\nApril 10 Research<\/a><\/td>\n<\/tr>\n
May 8th<\/td>\nMay Agenda<\/a>
\nApril Minutes<\/a><\/td>\n<\/tr>\n
June 12th<\/td>\nJune Agenda<\/a>
\nMay Minutes<\/a>
\nWorksheet<\/a>\/Evidence Table<\/a>\/PSPS Notification<\/a><\/td>\n<\/tr>\n
July 10th<\/td>\nJuly Agenda<\/a>
\nJune Minutes<\/a>
\nSKC Heat Plan<\/a>\/SKC Wildfire Smoke Plan<\/a>\/Evidence Table<\/a><\/td>\n<\/tr>\n
August 14th<\/td>\nAugust Agenda<\/a>
\nJuly Minutes<\/a><\/td>\n<\/tr>\n
September 11th<\/td>\nSeptember Agenda<\/a>
\nAugust Minutes<\/a>
\nDraft Guidelines<\/a><\/td>\n<\/tr>\n
October 9th<\/td>\nOctober Agenda<\/a>
\nSeptember Minutes<\/a>
\nDraft Guidelines<\/a><\/td>\n<\/tr>\n
November 13th<\/td>\nNovember Agenda<\/a>
\nOctober Minutes<\/a>
\nDraft Report & Guidelines<\/a><\/td>\n<\/tr>\n
December 11th<\/td>\nDecember Agenda<\/a>
\nNovember Minutes<\/a>
\nChecklist-Clinician<\/a>\/Checklist-Plans<\/a>\/Checklist-OutpatientClinic<\/a>\/Eval Plan<\/a>\/Eval Matrix<\/a><\/td>\n<\/tr>\n
January 15th, 2025<\/td>\nJanuary Agenda<\/a>
\nDecember Minutes<\/a>
\nFinal Draft Report<\/a>\/Public Comment Matrix<\/a>\/Public Comment Summary<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Award Winners” tab_id=”1739398231287-11fcf8a8-5994″][vc_column_text css=””]Add Award Winners here[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][vc_column_text css=””]<\/p>\n

Don\u2019t have an account?<\/strong> Click here to sign up for MemberLeap.<\/a><\/p>\n

Already have an account?<\/strong> Click the \u201cMessage Board\u201d<\/strong> button below to log in and view content.<\/p>\n

[\/vc_column_text][vc_btn title=”Message Board” color=”blue” size=”lg” align=”center” css=”” button_block=”true” link=”url:https%3A%2F%2Ffhqc.qualityhealth.org%2Fmembers%2Fforum%2Ftopic_list.php%3Fbid%3D4445315″][vc_separator color=”custom” border_width=”10″ css=”” accent_color=”#145E61″][vc_tta_tour style=”outline” shape=”square” color=”black” spacing=”20″ active_section=”1″ no_fill_content_area=”true” title=”LGBTQ Care”][vc_tta_section title=”Guideline Information” tab_id=”1730214474318-7f492288-7f84″][vc_column_text css=””]<\/p>\n

Guideline title: LGBTQ Care Report and Guidelines<\/h4>\n

Publication Status: <\/strong>Active
\n<\/strong><\/p>\n

Date of publication<\/strong>: 2018<\/p>\n

Date of last evidence search: <\/strong>2018<\/p>\n

Scope: <\/strong>Communication, l<\/span>anguage<\/span>, and i<\/span>nclusive e<\/span>nvironments; screening; data collection; vaccination; care and services.
\n<\/span><\/span><\/p>\n

Methods:<\/strong> Current guidelines and literature review and expert consensus<\/p>\n

Description: <\/strong>The workgroup aims to develop guidelines with a manageable scope that can be adopted by <\/span>clinics, hospitals, health systems, and health plans.<\/span> Guidelines are based<\/span> in a whole<\/span>–<\/span>person care <\/span>framework, taking into consideration<\/span> a<\/span>n<\/span> individual<\/span>\u2019s<\/span> multipl<\/span>e<\/span> factors that make up health,<\/span> wellness<\/span>, and <\/span>experience<\/span> (e.g., behavioral health,<\/span> past trauma, race\/ethnicity<\/span>) in such a way<\/span> th<\/span>at is not identity or <\/span>diagnosis<\/span>–<\/span>limiting.<\/span> We recommend that all health care encounters<\/span> should<\/span> occur using non<\/span>–<\/span>judgmental<\/span>, <\/span>non<\/span>–<\/span>sti<\/span>gmatizing language, body language, and tone.<\/span> Our guidelines are oriented mainly<\/span>, but <\/span>not exclusively,<\/span> to primary<\/span> care<\/span>, and include<\/span> guidelines directed to hospital settings, health <\/span>plans, health care purchasers, and patients themselves.<\/span><\/span><\/span>
\n<\/span><\/span><\/strong><\/p>\n

Supporting Materials<\/h4>\n

Department of Health Letter Accepting LGBTQ Health Care Recommendations<\/a><\/span>
\nHealth Care Authority\u00a0Letter Accepting LGBTQ Health Care Recommendations<\/a><\/span>
\nLGBTQ Health Care Workgroup Charter and Roster<\/a><\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Read On-line” tab_id=”1730214474585-54957e70-d1aa”][vc_column_text css=””]<\/p>\n

LGBTQ Health Care Report and Guidelines<\/a><\/h3>\n

[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Resources and Tools” tab_id=”1730214474860-a8748f2d-fa53″][vc_toggle title=”Resources and Tools”]WSHA Patient-Centered SOGI Data Collection<\/a><\/p>\n

National LGBTQIA+ Health Education Center: Learning Modules<\/a><\/p>\n

Celebrating Our Magic: Resources for AIAN Transgender and Two-spirted youth, relatives and families, and healthcare providers<\/a><\/p>\n

Seattle Children’s Patient and Family Education\u00a0<\/a><\/p>\n

CDC LGBTQ+ Youth Resources<\/a><\/p>\n

The Trevor Project<\/a><\/p>\n

GLAAD Resource list<\/a>[\/vc_toggle][vc_toggle title=”Evaluation Tools”]Toggle content goes here, click edit button to change this text.[\/vc_toggle][vc_video link=”https:\/\/www.youtube.com\/watch?v=2a427uSxGSc” title=”Related Bree Webinars Link”][\/vc_tta_section][vc_tta_section title=”Metrics and Evaluation Tools” tab_id=”1730214475537-8db2da74-efa2″][vc_column_text css=””]<\/p>\n

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To support health system improvement the Bree Collaborative has created score cards that are designed to help measure progress on the implementation of our guidelines. These were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)<\/p>\n

To use our score cards, find the audience type, or types, that is closest to your organization or area of improvement work and download the document. There may be more than one \u201caudience\u201d type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.<\/p>\n

Score cards are also aligned with the Bree Collaboratives\u2019 self-report data collection efforts. Organizations are not required to report, however anyone can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.<\/p><\/div>\n<\/div>\n

[\/vc_column_text][vc_toggle title=”Delivery Site and Health System”]Health System Evaluation Score Card \u00a0Health System Score Card _ LGBTQ<\/a>[\/vc_toggle][vc_toggle title=”Health Care Professionals”]Clinician Score Card\u00a0 Clinician Score Card _ LGBTQ<\/a>[\/vc_toggle][vc_toggle title=”Health Plans”]Health Plan Score Card\u00a0 Health Plan Score Card _ LGBTQ care<\/a>[\/vc_toggle][vc_toggle title=”Washington State Agencies”]Washington State Agency Score Card WA State Agencies Score Card _ LGBTQ care<\/a>[\/vc_toggle][vc_toggle title=”Private and Public Purchasers”]Employer\/ purchaser Score Card\u00a0 Employer Score Card _ LGBTQ care<\/a>[\/vc_toggle][vc_toggle title=”Guideline Metrics”]The work group recommends tracking the number of patients who identify as lesbian, gay, bisexual, and transgender. Additionally, Healthy People 2020 includes two Lesbian, Gay, Bisexual, and Transgender Health related metrics:<\/p>\n