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Partnering with the community to improve health: Using Lay Health Educators to improve asthma management among African-American children in Chicago DeShuna.

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Presentation on theme: "Partnering with the community to improve health: Using Lay Health Educators to improve asthma management among African-American children in Chicago DeShuna."— Presentation transcript:

1 Partnering with the community to improve health: Using Lay Health Educators to improve asthma management among African-American children in Chicago DeShuna Dickens, MPH, AE-C CityMatCH Conference August 26, 2007

2 2 Outline BackgroundBackground –Epidemiology of Asthma –Asthma in Chicago Pediatric Asthma Initiative – 2 (PAI-2) Lessons Learned / Challenges Recommendations

3 3 Epidemiology of Asthma 9 million children (12% of children <18 yrs) in the U.S. have asthma (NHIS 2004) Inner-city, minority children experience a disproportionate asthma burden –Prevalence approaches 1 in 4 –Many rely primarily on ED for asthma care In 2003, IL spent $800 million providing medical care to Medicaid-insured persons with asthma –More than a quarter of that was related to inpatient hospitalizations ($225 million)

4 4 Supported by The Robert Wood Johnson Foundation and The Chicago Community Trust Sinai Health System Improving Community Health Survey Report 1, Jan 2004 Report 2, Sept 2005

5 5 Chicago Community Area Map

6 6 % of Children (0-12 yrs) with Physician Diagnosed and Screened Asthma *National Health Interview Survey, 2004 Physician Diagnosed - U.S. *

7 7 Asthma Study in Harlem Study: 1 in 4 Harlem Children Has Asthma (asthma defined as diagnosed + screened for asthma) Front Page, New York Times, 4/19/03 “One of every four children in central Harlem has asthma, which is double the rate researchers expected to find and, experts say, is one of the highest rates ever documented for an American neighborhood.” - New York (AP)

8 Funded by the Illinois Department of Public Health November 2004 – August 2006 Use of Lay Health Educators to Improve Asthma Management Among African American Children (PAI-2)

9 9 Instigated by the findings of the Improving Community Health Survey Goal: to improve asthma management among inner- city African American children with severe asthma and thereby: (1) decrease asthma-related morbidity and (2) improve quality of life. Pilot grant from IDPH –Builds on experiences with PAI (Findings published in Journal of Asthma 2007;44: 39-44) PAI-2: Overview

10 10 PAI-2: Overview (cont.) Utilizes Lay Health Educators (LHE) – a.k.a Community Health Educators, Peer Educators, etc. Characteristics: –From the community –Culturally sensitive to needs of community & accepted by the community –Attend 15-20 hour training with a AE-C; also receive on-going training with Pediatric Pulmonologist

11 11 Education is tailored to family’s unique needs, and is provided in the family’s home whenever possible LHE meet with families 3-4 times over 6 month period LHE also serves as a liaison between the family and the medical system PAI-2: The Intervention

12 12 Home Visit – Topics covered: What is asthma? Recognizing symptoms of asthma attack What to do during an asthma attack Medications – quick-relief vs. long term controller How to properly use medications and devices Trigger identification and avoidance –Passive cigarette smoke PAI-2: The Intervention (cont.)

13 13 African American children (2-16 yrs) w/ prior diagnosis of asthma –Symptoms for at least 1 year pre-enrollment One of following eligibility criteria: –Hospitalized for asthma during the past 12 months –Visited ED for asthma during the past 12 months –Asthma symptoms indicative of at least moderate persistent asthma Had not participated in another comprehensive asthma education program in past year PAI-2: Participants

14 14 Recruited primarily through Sinai’s ED and inpatient units Physician referrals of children with severe asthma symptoms (moderate persistent asthma) LHEs contact primary caregiver of child to assess eligibility and interest –Ideally contacted w/in one week of ED visit or hospitalization 70 children enrolled 11/15/2004-7/13/2005 PAI-2: Participants

15 15 PAI-2: Baseline Data – Health Resource Utilization Enrolled participants had a history of frequent urgent health care utilization In the year prior to the intervention, the average child had: –3.1 ED visits –0.7 hospitalization –2.7 visits to a doctor for worsening symptoms –Been to the ED, hospitalized, or to a doctor for worsening asthma symptoms 6.5 times

16 16 PAI-2: Baseline Data 90% of children had asthma that is poorly controlled per NHLBI standards 54% of children lived with a smoker Substantial confusion over medications and their proper use

17 17 PAI-2: Findings 58/70 (82.9% of enrolled) completed the 6 month intervention phase 50/70 (71.4% of enrolled) completed the 12 month follow-up Findings presented based on these 50 children

18 18 PAI-2: Findings (cont.) Primary Goal 1: Decrease asthma-related morbidity –Decrease the frequency and severity of asthma symptoms and exacerbations –Decrease urgent health resource utilization

19 19 PAI-2: Symptom Frequency (past 2 wks) - BL vs. Average Over FU Period * * * * p < 0.05

20 20 PAI-2: Asthma Health Resource Utilization - BL vs. FU Year * * * * p < 0.05 * **Outliers not included in analysis; n=49 ***Sum of Hosp., ED and Urgent Clinic visits. Outliers not included in analysis; n=49

21 21 PAI-2: Findings (cont.) Primary Goal 2: Improve Quality of Life –Pediatric Asthma Caregiver’s Quality of Life 1 BL, 6M, 12M 1. Juniper EF, et al. Quality of Life Research 1996; 5: 27-34.

22 22 PAI-2: Quality Of Life Scores – BL vs. 6 Month FU and 12 Month FU * * * * p < 0.05 * * *

23 23 PAI-2: Findings (cont.) – Secondary Goals GoalM6M12 Improve asthma-related knowledge of primary caregiver  Improve confidence of primary caregiver to manage asthma  Decrease exposure to triggers, especially cigarette smoke  Increase proportion of children with Asthma Action Plan  NA Improve medication technique  NA

24 24 PAI-2: Summary of Key Findings Improved asthma control Decreased asthma-related urgent health resource utilization in follow-up year Statistically and clinically improved Quality of Life Scores by M6 and continuing through M12 Increased asthma-related knowledge maintained through M12 Decreased exposure to asthma triggers in home environment Improved use of medications Significant anecdotal evidence of success

25 25 PAI-2: Conclusions Individualized, one-on-one, asthma education provided by a trained, culturally competent, LHE in the home environment may prove an effective means of educating children with poorly controlled asthma and their families to better manage asthma

26 26 PAI-2: Conclusions (cont.) Pilot study provides evidence of improved asthma outcomes, quality of life and asthma- related knowledge, and decreased exposure to triggers among families participating in the intervention Intervention likely cost effective (work in progress)

27 27 Outline Background –Epidemiology of Asthma –Asthma in Chicago Pediatric Asthma Initiative – 2 (PAI-2) Lessons Learned / ChallengesLessons Learned / Challenges Recommendations

28 28 Lessons Learned Hiring/Training/Supervising the LHE Development of a personal relationship with the family Inclusion of all family members in education Alternative approach for reaching teens

29 29 Challenges Transient population No control over environment Use of a primary care physician Physician buy-in Cigarette smoke exposure in homes

30 30 Outline Background –Epidemiology of Asthma –Asthma in Chicago Pediatric Asthma Initiative – 2 (PAI-2) Lessons Learned / Challenges RecommendationsRecommendations

31 31 Recommendations Randomized Controlled Trial Expand model to other populations –Controlling Pediatric Asthma through Collaboration and Education (CPATCE) Test long-term effectiveness Funding/Reimbursement for LHE programs Continue to evaluate and publish findings on the effectiveness of LHE programs

32 32 Asthma in a child’s life: From Ordinary Resurrections by Jonathan Kozol: “I think that asthma’s worse for children, though, because play is a part of childhood and children cannot play with real abandon when they feel so bad. Even mild asthma weighs their spirits down and makes it hard to smile easily, or to read a book with eagerness or to jump into a conversation with entire spontaneity.”

33 33 It takes a village… Steve Whitman – Principal Investigator Helen Margellos-Anast – Project Director Gloria Seals – Health Education Coordinator DeShuna Dickens – Asthma Education Coordinator Melissa Gutierrez – Evaluation Coordinator Jeanette Avila – Research Assistant Sheena Freeman – Research Assistant Ana Rosa Garcia, Yolanda Curtis and MiCrystal Smith – Lay Health Educators Deepak Jajoo – Co-Investigator/Medical Advisor, Pediatric Pulmonologist

34 For more information on SUHI For more information on Sinai Children’s Hospital

35 35

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