Title: Home visits by public health nurses to reduce environmental triggers of asthma: Successes, challenges and policy implications

BACKGROUND: Minnesota has implemented successful asthma home visiting (AHV) projects in urban cities using a respiratory therapist. Communities Reducing Environmental Triggers of Asthma Project's goal was to ascertain if similar success would occur if the program was implemented in different geographic areas (rural, suburban, and Tribal Nation) using public health nurses (PHN's). This would support efforts to develop the capacity to offer AHV statewide. DESCRIPTION: PHN's and Tribal environmental health (EH) home visiting staff received training in asthma management techniques, environmental home assessment and low-cost/no-cost interventions. Data analyzed from 2008-2009 showed statistically significant reductions in the number of emergency department visits, unscheduled office visits, number of episodes of oral prednisone as well as an improvement in quality of life. The return on investment was $5.25 per $1.00 spent. LESSONS LEARNED: Providing in-home education, an environmental assessment of the home and low-cost product interventions are essential program components. With training, PHN's serving suburban and rural communities and Tribal EH staff can obtain successful outcomes. Additional program costs and logistics make it difficult to sustain such a program without some changes. Evaluation results suggest that a more standardized visit such as outlined in the Omaha System individual asthma pathway be followed. RECOMMENDATIONS: Given the return on investment and the potential for improvement in quality of care, health plans and Minnesota Health Care Programs provide reimbursement to PHN's for asthma home visits to children with uncontrolled asthma. Training should be provided to assure that qualified staff are available to implement the program statewide.