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Montana Asthma Project Update: Summer 2011
Katie Church, RN, MSN, MPH - MACP Health Educator
What is the Montana Asthma Project?
* A home-based, multi-component intervention to address asthma
* Targets children with asthma and their families
* Includes both environmental and educational components
Evidence Base
* The CDC’s Community Guide
- Recommends “home-based multi-trigger, multi-component interventions with an environmental focus for children and adolescents with asthma”
- “The combination of minor to moderate environmental remediation with an education component provides good value for the money invested”
* Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma
- “Asthma education delivered in the homes of caregivers of young children be considered”
- “Multifaceted allergen education and control interventions delivered in the home setting” be utilized for asthma patients with allergies
MAP Goals
* Increase asthma control and quality of life
* Increase knowledge of symptom management
* Increase knowledge of how to reduce and/or eliminate environmental triggers
Goal progress measured with knowledge surveys, symptom frequency monitoring, Asthma Control Test
Home Nurse Visitors and MAP sites
* Registered nurses will conduct the home visits
- Chosen sites must have previous home visiting experience
- Means of acquiring referrals
- No special knowledge of asthma required
Bullhook Community Health Center in Havre
Lewis and Clark City/County HD in Helena
Missoula City/County HD in Missoula
Program participants
* Children (aged 0 to 17) with diagnosed asthma, and their families
- Live in same geographic area as pilot site AND
- Have had at least one visit to ED or urgent care or an overnight hospitalization OR
- Scored less than 20 on the Asthma Control Test within the previous year
* Numbers?
Six Visits/Contacts
* Initial visit, and at months 2, 4, 6, 9,& 12
* Visits at months 4 and 9 can be phone calls
* Education, symptom frequency assessment, home environment assessment for asthma triggers
* Nurse records visit data in spreadsheet to be submitted to MACP at intervals
Training
* Two days in Helena
- Pharmacology
- Environmental home assessment
- Data collection
- Educational techniques
- Overall program instructions
* Nurses received
- Educational curriculum and related handouts
- Durables: clipboards, flashlights, bedcovers, HEPA filters…
Before the first visit…
* Sites have been gathering enrollees to the program using existing resources
- Medicaid Health Improvement Program roster
- Community physicians, pharmacists, other program staff
- Local media
- Community events
Katie Church, RN, MSN, MPH - MACP Health Educator
What is the Montana Asthma Project?
* A home-based, multi-component intervention to address asthma
* Targets children with asthma and their families
* Includes both environmental and educational components
Evidence Base
* The CDC’s Community Guide
- Recommends “home-based multi-trigger, multi-component interventions with an environmental focus for children and adolescents with asthma”
- “The combination of minor to moderate environmental remediation with an education component provides good value for the money invested”
* Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma
- “Asthma education delivered in the homes of caregivers of young children be considered”
- “Multifaceted allergen education and control interventions delivered in the home setting” be utilized for asthma patients with allergies
MAP Goals
* Increase asthma control and quality of life
* Increase knowledge of symptom management
* Increase knowledge of how to reduce and/or eliminate environmental triggers
Goal progress measured with knowledge surveys, symptom frequency monitoring, Asthma Control Test
Home Nurse Visitors and MAP sites
* Registered nurses will conduct the home visits
- Chosen sites must have previous home visiting experience
- Means of acquiring referrals
- No special knowledge of asthma required
Bullhook Community Health Center in Havre
Lewis and Clark City/County HD in Helena
Missoula City/County HD in Missoula
Program participants
* Children (aged 0 to 17) with diagnosed asthma, and their families
- Live in same geographic area as pilot site AND
- Have had at least one visit to ED or urgent care or an overnight hospitalization OR
- Scored less than 20 on the Asthma Control Test within the previous year
* Numbers?
Six Visits/Contacts
* Initial visit, and at months 2, 4, 6, 9,& 12
* Visits at months 4 and 9 can be phone calls
* Education, symptom frequency assessment, home environment assessment for asthma triggers
* Nurse records visit data in spreadsheet to be submitted to MACP at intervals
Training
* Two days in Helena
- Pharmacology
- Environmental home assessment
- Data collection
- Educational techniques
- Overall program instructions
* Nurses received
- Educational curriculum and related handouts
- Durables: clipboards, flashlights, bedcovers, HEPA filters…
Before the first visit…
* Sites have been gathering enrollees to the program using existing resources
- Medicaid Health Improvement Program roster
- Community physicians, pharmacists, other program staff
- Local media
- Community events
Cindy Smith, RN BSHA
Chief Executive Officer
Chief Executive Officer
Brandi Baker, RN
Asthma Case Manager
Interim MMHIP/MAP Supervisor
Asthma Case Manager
Interim MMHIP/MAP Supervisor
Recruiting Enrollees - Montana Medicaid Health Improvement Program
- Radio & Newspaper Ads
- Havre Public School District’s School Nurse
- Community Events
- Local Clinics
Patient Demographics
32 patients enrolled in program to date
20 active patients (have had at least one home visit)
3 patients that dropped from program after first home visit
2 patients that enrolled and dropped before first visit
7 patients that are enrolled but have not had their first visit.
- 47% Native American, 47% Caucasian, <1% Two or more races, <1% Latino
Successful Home Visits
Establish rapport first
Discuss the home assessment on the phone prior to the first visit, and again before conducting the assessment
Start small when it comes to environmental changes
Notable Findings
- Lack of knowledge of asthma symptoms
- Most parents do not recognize coughing as a symptom of asthma
- Discrepancy between frequency of symptoms reported by parents and patients
- Parents tend to not take early warning symptoms seriously
- Even parents who have asthma themselves have a knowledge deficit
Future of the Montana asthma project home visiting program
- Provider/Case Manager relationships
- Follow up with younger children
- Working with schools to promote healthy school environments
- Peak flow meter use as a measurable outcome
- Radio & Newspaper Ads
- Havre Public School District’s School Nurse
- Community Events
- Local Clinics
Patient Demographics
32 patients enrolled in program to date
20 active patients (have had at least one home visit)
3 patients that dropped from program after first home visit
2 patients that enrolled and dropped before first visit
7 patients that are enrolled but have not had their first visit.
- 47% Native American, 47% Caucasian, <1% Two or more races, <1% Latino
Successful Home Visits
Establish rapport first
Discuss the home assessment on the phone prior to the first visit, and again before conducting the assessment
Start small when it comes to environmental changes
Notable Findings
- Lack of knowledge of asthma symptoms
- Most parents do not recognize coughing as a symptom of asthma
- Discrepancy between frequency of symptoms reported by parents and patients
- Parents tend to not take early warning symptoms seriously
- Even parents who have asthma themselves have a knowledge deficit
Future of the Montana asthma project home visiting program
- Provider/Case Manager relationships
- Follow up with younger children
- Working with schools to promote healthy school environments
- Peak flow meter use as a measurable outcome
The Montana Asthma Project is a one-year home visiting program designed for children ages 0-17 with uncontrolled or newly diagnosed asthma. The program provides 6 home visits over the course of one year with a Registered Nurse who is able to answer any questions you may have about your child s asthma and asthma medications. An asthma home assessment is conducted on the first visit to help your family identify potential triggers in the home environment and ways to reduce them. All children enrolled in the program receive periodic incentives for attending their appointments, asthma/allergy mattress and pillow covers to help reduce nighttime symptoms, and eligible children receive an air purifier with HEPA filter. Your home visiting nurse will work with your child s regular doctor to establish an asthma action plan and adjust his/her asthma medications as necessary. All services and products are free of charge, regardless of income or insurance. If your child is experiencing nighttime coughing more than twice a month or daytime symptoms more than twice a week, has been admitted to the ER or hospital for asthma symptoms within the last 6 months, or was recently diagnosed with asthma, please call 406-265-4541 or 406-399-1003 today to make an appointment.