Promoting Quality Asthma Care in Hospital Emergency Departments: Past, Present, and Future Efforts in Florida
Asthma-Friendly Homes Program
Data from our preliminary assessment of asthma management practices in Florida hospitals suggested that an important priority for improving emergency department asthma care is reducing repeat visits. Rates of repeated emergency department utilization for asthma management correlate inversely with both household income and quality of available resources for home self-management. Our team considered developing a home visiting program to bring asthma education programming and self-management tools to children and their families. Rather than trying to build a new program ourselves, we extended our focus on strategic partnership to the Florida department of health’s regional affiliate in Miami-Dade County, who were developing a home visiting intervention to reduce emergency department visits and improve continuity of care for children with asthma [9].
Early planning for the Miami-Dade program included a focus on low-income communities and households, including the homes of children with Latino and/or Haitian heritage. The Asthma-Friendly Homes Program was developed in partnership with Nicklaus Children’s Hospital, with the hospital and the local Department of Health affiliate sharing responsibility for program implementation and management as well as data collection [10]. Small adjustments were made to the overall program strategy as partner agencies began working with Florida Asthma Program managers and evaluators. Now in its second year of implementation, the Asthma-Friendly Homes Program continues to evolve and grow.
Preventing repeat visits to the emergency room in favor of daily self-management at home remains the central emphasis of the program. Its curriculum focuses on empowering children with asthma and their families to self-manage effectively and consistently. By consequence, the Asthma-Friendly Homes Program encourages patients to use emergency department care services only when indicated by signs and symptoms rather than as a primary source of care. To achieve these objectives, the program uses a combination of activities including home visits and regular follow-up by case management.
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.
