Delivery of the Asthma-Friendly Homes Program begins with determination of eligibility via medical records review. Data analysts from the regional Miami-Dade branch of department of health collaborate with case managers from Nicklaus Children’s Hospital to identify children who are eligible for participation. Eligibility criteria include 3 or more visits to the emergency room for asthma within the past year, related care costs totaling at least $50,000 in the past year, and residency in 1 of 7 target zip codes that represent low-income communities. When a child is deemed eligible, case managers contact their family to facilitate scheduling of a home environmental assessment by trained specialists from the department of health. During this visit, families receive information about common asthma triggers within their homes, and talk with environmental assessors about possible mitigation strategies that are appropriate for their specific economic and instrumental resources. At the conclusion of this visit, families are asked if they would like to receive an educational intervention to help their child build self-management skills in a supportive environment.
Families that wish to participate in the educational component of Asthma-Friendly Homes are then put in touch with a certified asthma educator employed by Nicklaus Children’s Hospital. Participants can schedule a preliminary visit with their asthma educator themselves, or work with case management at Nicklaus to coordinate intake for the educational program. Visiting asthma educators begin by completing a preliminary demographics, symptoms, and skills assessment with family members. They deliver 3 sessions of education for participating children, each time assessing progress using a standardized questionnaire. Although the evaluation instruments for these sessions are standard, the curriculum used by asthma educators is tailored to the needs of each individual child and their family. The demographics, symptoms, and skills assessment is repeated with family members at the end of the third visit from asthma educators. Finally, case managers follow up with families after 6 months to assess retention of benefits from the program.
Participating children are also tracked in the hospital’s emergency department records to contextualize success with home-based self-management. Like data from the questionnaires, this information gets shared with Florida Asthma Program evaluators. Our team uses these data to understand the effectiveness of the Asthma-Friendly Homes Program itself, as well as its utility for preventing repeated utilization of hospital emergency department services. The program currently has 9 families participating, which is on target for the early stages of our pilot program with Miami. As we evaluate Asthma-Friendly Homes, we hope that this program will become a new standard in evidence-based best practices for keeping children out of the emergency room and healthy at home, both in Florida and across the nation. To disseminate results from this intervention in ways that promote adoption of effective self-management curricula by organizations working with vulnerable populations, we are thus focusing intensively on building networks that facilitate this sharing.
Learning and Action Networks
Building on lessons learned from our evaluation of emergency department asthma care and delivery of interactive webinars, our team proposed a systems-focused approach for implementing and sharing knowledge gained from these activities. As such, the department of health is developing Learning and Action Networks. LANs are mechanisms by which large-scale improvement around a given aim is fostered, studied, adapted, and rapidly spread. LANs are similar to “communities of practice” in that they promote learning among peer practitioners, but differ in that they focus on a specific improvement initiative, in this case delivery of and reimbursement for comprehensive asthma management.