Suffolk County Department of Health Services Breathing Easy Program

State: NY Type: Model Practice Year: 2008

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Goals: “Breathing Easy” is an in-home educational program aimed at improving outcomes for indigent asthmatics after hospitalization or emergency room (ER) visit.

Four to six home visits are made by a public health nurse (PHN) to assess and instruct the patient and family. The PHN, during the home visit, uses computerized health education materials that are designed for those with low literacy skills. Additionally, this program uses the strengths and complementary resources of a community Asthma Coalition that targets asthma awareness, management, and outcome improvement. The home visits, as well as the supplemental resources, assist the patient and family to understand all the aspects of home asthma management. The program enables the patient and family to act in order to minimize the deleterious effects of the disease, improve disease management, prevent hospitalizations and ER visits, and enhance the quality of life for the patient through control of asthma.

Objectives: Assist the patient and family to understand all aspects of home asthma management. Minimize the deleterious effects of the disease and improve disease management. Enhance the quality of life for the patient through control of asthma, and minimize the rate of asthma-related hospitalizations and ER visits. Increase the education of patients with asthma and their families regarding effective asthma management, and decrease hospitalizations and ER visits by this cohort. Persons who have been diagnosed with asthma and have had a hospitalization or ER visit are referred for home visits by Suffolk County Department of Health Services (SCDHS) Public Health Nurse. The nurse, during the home visits, uses computerized health education materials that are designed for those with low literacy skills.

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Suffolk County Department of Health Services
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Suffolk County Department of Health Services Breathing Easy Program
Goals: “Breathing Easy” is an in-home educational program aimed at improving outcomes for indigent asthmatics after hospitalization or emergency room (ER) visit. Four to six home visits are made by a public health nurse (PHN) to assess and instruct the patient and family. The PHN, during the home visit, uses computerized health education materials that are designed for those with low literacy skills. Additionally, this program uses the strengths and complementary resources of a community Asthma Coalition that targets asthma awareness, management, and outcome improvement. The home visits, as well as the supplemental resources, assist the patient and family to understand all the aspects of home asthma management. The program enables the patient and family to act in order to minimize the deleterious effects of the disease, improve disease management, prevent hospitalizations and ER visits, and enhance the quality of life for the patient through control of asthma. Objectives: Assist the patient and family to understand all aspects of home asthma management. Minimize the deleterious effects of the disease and improve disease management. Enhance the quality of life for the patient through control of asthma, and minimize the rate of asthma-related hospitalizations and ER visits. Increase the education of patients with asthma and their families regarding effective asthma management, and decrease hospitalizations and ER visits by this cohort. Persons who have been diagnosed with asthma and have had a hospitalization or ER visit are referred for home visits by Suffolk County Department of Health Services (SCDHS) Public Health Nurse. The nurse, during the home visits, uses computerized health education materials that are designed for those with low literacy skills.
Since 1980, asthma prevalence, hospitalization, and mortality have been increasing in New York State; The incidence varies according to racial/ethnic and other demographics; Six percent of Mexican Americans, 8 percent of white Hispanics, 13 percent of African American non-Hispanics, and 19 percent of Puerto Ricans have been diagnosed with asthma (Centers for Disease Control and Prevention [CDC], 2007, www.cdc.gov); The overall incidence of asthma in New York averages almost 10 percent (CDC, 2006), and low income and ethnic minorities are disproportionately affected (National Institute for Healthcare Management [NIHCM], 2007, www.nihcm.org); Incidence is higher for homeless (40 percent); among that cohort only 15 percent are taking asthma controller medications. ER use for this cohort is 59 percent; A disproportionately higher burden of asthma falls on the disadvantaged ethnic minorities in the suburban population of Suffolk County. The rate of hospital-related discharges for asthma in that population is 84.2 per 10,000, which is more than three times the Healthy People 2010 Objective (25.0/10,000), and almost three times the rate for the remainder of the county (30.5/10,000) (New York State Department of Health, 2006, www.health.ny.us); Risk factors for increased asthma-related mortality and morbidity have been documented in this population, including poor and crowded living conditions, exposure to environmental pollutants, limited health insurance coverage, poor access to medical care, and lack of self-management skills; and Suffolk County extends 912 square miles over the eastern end of Long Island, and has a population of 1.4 million residents. The county’s population is larger than that of more than 12 states, and the community profile includes both suburban and rural characteristics. The particular geography of the county poses difficult challenges to mobility and tends to isolate low-income residents who rely on the county’s public transportation system. Thus, the availability of home visiting is an efficacious modality in which to provide healthcare that result in improved health outcomes.
Agency Community RolesSCDHS was the lead agency for the project, and all enrollees received both their ambulatory care and public health nursing intervention through the department. The level of citizen participation in government programs was enhanced through the program’s partnership and collaboration of the community coalition, the Asthma Coalition of Long Island, which: Is a multidisciplinary coalition that maximizes the use of resources to benefit children with asthma, has more than 80 community members, and members include healthcare providers, schools, community organizations, and individuals with asthma; Provides resources, such as computers (for Public Health Nurses to take into the home for educational purposes), design of computerized and print health educational materials, hardware and software, and technical assistance, expertise, and advocacy; Provides support and advocacy for public policy changes needed to implement program. Costs and ExpendituresIn-kind services will be provided by community partnerships (e.g., the American Lung Association’s Asthma Coalition of Long Island, area hospitals) and SCDHS (current professional and administrative staff time to develop project). ImplementationA baseline assessment of the patient, family, and environment, including a physical exam, and evaluation of growth and developmental status (if patient is a child), Determination of the patient’s and family’s (if appropriate) level of understanding of all aspects of asthma and its management, An assessment of the home environment. All PHN staff received requisite skill building and education in order to be able to proficiently provide the interventions. Teaching sessions range from four to six visits. The number of visits is dependent on the above assessments and the ability of the family and patient to assimilate the necessary information and incorporate life style changes. Goal for visiting is twice a week for the first week and weekly for the subsequent weeks. Laptop computers are made available to all PHN making home visits to patients with a diagnosis of asthma. Computerized program developed using strategies known to be effective with those with low literacy skills (in both Spanish and English). Both print and computerized materials were developed at a sixth-grade reading level. Both print and audiovisual health education materials are used during the visit. The program was developed over a three-month period when a small team met in order to develop objectives, outcome measures, and program details. The implementation took place over a period of a year, during which time the team met regularly in order to coordinate program details and collect pre-enrollment data for enrollees.
Pre- versus post-intervention differences in ER outcomes were measured using a paired samples t-test. The number of ER visits for asthma for the year following completion of the program dropped to an average of 0.37 per enrollee from an average of 1.39 per enrollee for the year prior to care, reflecting statistically significant reductions in use of asthma-related ER visits for this cohort (p = 0.001); Pre- versus post-intervention differences in hospitalization outcomes were measured using a paired samples t-test. The number of hospitalizations for asthma for the year following completion of the program dropped to an average of 0.25 per enrollee from an average of 0.61 per enrollee for the year prior to care, reflecting statistically significant reductions in use of asthma-related hospitalizations for this cohort (p > 0.058); The average Medicaid savings per enrollee amounted to $19,000 per enrollee over a one year period; and, An in-home asthma education program, when including health education materials that are specifically designed for the target population, demonstrates improvement in both asthma management and control.
Reimbursement comes from third-party insurance sources and can easily be sustained. Available resources continue to be used with existing revenue streams. The local community health centers and hospitals have seen the positive effects of the Breathing Easy program, and have incorporated the program into their referral sources and processes.
 
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