203367 Clinical outcomes of a pediatric asthma home visiting program

Monday, November 9, 2009: 2:50 PM

Mikki Meadows-Oliver, PhD, APRN , School of Nursing, Yale University, New Haven, CT
Martha Kirk Swartz, PhD, RN, FAAN , School of Nursing, Yale University, New Haven, CT
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.

Learning Objectives:
1. To describe the effect of enrollment in a nurse-led asthma home visiting program on a number of common clinical markers including the number of missed school days, courses of oral steroid therapy, emergency department (ED) visits, primary care provider (PCP) visits, admissions to the intensive care unit (ICU), and intubations. 2. To discuss nurses’ ratings of enrolled children's adherence to recommended therapy.

Keywords: Asthma, Pediatrics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a pediatric nurse practitioner who was employed for 5 years by the Asthma Outreach Program, a home visiting providing education and asthma resources to pediatric patients and their families. My education includes Masters' degrees in Nursing and Public Health from Yale University. I also have a PhD in Nursing from the University of Connecticut. I have been on local/regional governmental committees that dealt with issues related to children with asthma and their families (2004-2005 City of New Haven Asthma Initiative; 2005-2007 New Haven County Regional Asthma Program). I have also published articles relating to the care of children with asthma: Banasiak, N. & Meadows-Oliver, M. (2004). Inpatient clinical pathways for pediatric asthma: An integrative review. Pediatric Nursing, 30, 447-450. Banasiak, N. & Meadows-Oliver, M. (2005). Leukotrienes: Their role in the treatment of asthma and allergic rhinitis. Pediatric Nursing, 31, 35-38. Swartz, M., Banasiak, N., & Meadows-Oliver, M. (2005). Barriers to Effective Pediatric Asthma Care. Journal of Pediatric Health Care,19, 71-79. Meadows-Oliver, M. & Banasiak, N. (2005). Asthma Medication Delivery Devices. Journal of Pediatric Health Care, 19, 121-123. Gustafson, E., Meadows-Oliver, M. & Banasiak, N. (2008). Asthma in Childhood. Chapter 5. In T. Gullota & G. Blau (Eds). Handbook of Childhood Behavioral Issues: Evidenced-Based Approaches to Prevention and Treatment. New York: Routledge, Taylor & Francis Group, LLC. I have also presented regionally and nationally on issues related to children with asthma: Asthma Information: When to Use the Web. 1st Annual Connecticut Children’s Medical Center National Pediatric Conference. Hartford, CT. September 27, 2007. Quality of Unsponsored Asthma Websites. 28th Annual Conference. National Association of Pediatric Nurse Practitioners. Orlando. FL, March 22, 2007. Co-Presenter: Nancy Banasiak. An Evaluation of Sponsored Asthma Websites. Pediatric Nursing 21st Annual Conference. Philadelphia, PA. September 17, 2005. Co-Presenter: Nancy Banasiak. Effectiveness of Inpatient Pediatric Clinical Pathways for Asthma: An Integrative Review. 2nd Annual APRNet Conference, New Haven, CT. September 26, 2003.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.