Clinical outcomes of a pediatric asthma home visiting program

Background: Improving self and family management of asthma in pediatrics often necessitates understanding the home management of potentially complex medical protocols. Home visiting is an approach for asthma management that takes advantage of the home context to modify services so that they address both individual and family needs. In-home education provided by nurses has been shown to improve outcomes for children with asthma. The goal of this clinical research project was to evaluate the clinical outcomes of a nurse-led intensive intervention provided to asthmatic children enrolled in an asthma home visiting program.

Methods: A retrospective chart review was conducted to examine the effect of enrollment in the nurse-led asthma home visiting program on health care utilization outcomes for six months prior to enrollment and six months post-enrollment. A convenience sample of 37 children with chronic asthma that were enrolled in the nurse-led asthma home visiting program was utilized for this study. Ages ranged from 6 to 16 years (mean 9.1 years) at the time of enrollment. Descriptive statistics were determined for each variable. Each subject served as its own control. Because the sample was not normally distributed, non-parametric tests (Wilcoxon rank-sum test) were conducted to compare scores on the variables of interest between the 6 month time period prior to enrollment and the 6 months post-enrollment.

Results: Compared to the six months prior to enrollment, the patients enrolled in the nurse-led asthma home visiting program had significantly fewer nighttime symptoms, primary care provider visits for asthma, courses of oral steroids to treat asthma exacerbations, hospitalizations, and ICU admissions six months after enrollment. They also demonstrated significantly better adherence to their asthma therapy regimen.

Conclusion: In summary, an advantage of conducting home visits for children with asthma includes being able to use actual home conditions to tailor the asthma education to meet families' needs. Nurses working with the families that participated in the asthma home visiting program were able to help families have improved clinical outcomes regarding a variety of factors. Because of the small sample size, this study should be replicated using a larger sample, possibly in a randomized-control trial.