Asthma Health Outcomes Project
Overviews of Surveyed Asthma ProgramsSeptember 2005
Domestic Programs: New York (cont’d)
Evaluating Home/Environmental and Clinical Interventions for Asthma in HRSA-Funded Community/Migrant Health Centers
Clinical Directors Network, Inc. (CDN)
New York, NY
Jonathan N. Tobin, PhD
(212) 382-0699 ext. 234
(training and CD-ROM)
Evaluating Home/Environmental and Clinical Interventions for Asthma in HRSA-funded Community/Migrant Health Centers(C/MHCs) was a randomized, controlled trial in pediatric patients of C/MHCs to test the feasibility and effectiveness of a combination of interventions that have been shown to reduce symptoms and improve outcomes in previous studies. The project was managed by Clinical Directors Network (CDN – www.CDNetwork.org ), a non-profit practice-based research network of C/MHCs and clinical leaders.
Participants included 220 children, aged 6-19 years, who had mild persistent to severe asthma, documented use of beta-agonist and two or more visits to the C/MHC in the previous year. Thirteen C/MHCs and one managed care organization located in NY, NJ, MO, PA, Puerto Rico and the US Virgin Islands participated in the project. The project was funded by the Environmental Protection Agency – Radiation and Indoor Air Branch - Region II, HRSA Region II and NJ Department of Environmental Protection.
Prior to implementation of activities to children, clinicians were trained on the components of the program and its guidelines. Once providers were trained and patients were recruited and randomized, a trained outreach worker visited the patient's home and performed a visual trigger assessment. Allergen reduction recommendations were given based on the assessment. A product package was provided to the family, which included mattress and pillow covers, pest management products, and hypoallergenic laundering and cleaning products. An education session was provided regarding correct use of inhalers, asthma medications, asthma management plans, and physical activity. An RN administered telephone surveys every two weeks to patients and provided feedback to the patients' providers regarding emergency room visits, hospitalizations, change in medication, and other outcomes.
Evaluation results revealed significant improvements in the following health outcomes: hospitalizations, emergency department visits, unscheduled office visits, school absences, symptoms (asthma morbidity), change in medical treatment plan (providing an AAP), and self-management skills. Increased behaviors aimed at reducing exposure to cockroach allergen and dust mites were also observed.
A more detailed summary of the results is available at: www.CDNetwork.org/PDFS/EPA%20Asthma%20.pdf
Sustainable resources include free online materials: Online CME-accredited Courses in English & Spanish - www.CDNetwork.org/webcast_library.htm
Clinical decision-support tools - www.eClinician.org/etools.htm
Patient education materials and patient self-management tools are available on a CD-rom at: www.CDNetwork.org/Asthma%20CD-ROM.htm
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