Asthma Home Visit Protocols

We are working with the Philadelphia Dept of Health on a "Healthy Homes Initiative."  This will involve home visits during which environmental triggers for asthma(mold etc..) will be identified and hopefully addressed.

    We hope to collect baseline data on levels of asthma control prior to the intervention and then assess any changes post intervention.  To those groups that have done these kinds of programs and studies before, any suggestions on what questions we should ask and what outcomes we should measure? 

      Also any advice on dealing with IRB issues would be welcome!

      Thanks in advance for you input.

                    Jerry Goldstein, M.D.

                    St. Christopher's Hospital for Children

For many years our Clean Air for Kids program in Pierce County, WA collected self-reported data from families regarding missed work/school days, change in ER/Urgent care visits, Quality of Life and behavior change.  We saw consistent positive results with these outcomes.  Currently we use the standardized Asthma Control Test at time of visit and again 6-8 weeks post visit.  We are looking at changes in ACT score and hoping for consistent improved scores.  The Asthma Control Test is nice because it is the same one that our local children's hospital uses and families can then compare there scores with that as well.  Healthcare providers are also familiar with it and information with the child's ACT score at time of visit is sent to their primary care provider.

Happy to provide more details- Judy Olsen, EHS and AE-C   jolsen@tpchd.org

The Healthy Neighborhoods Programs of NYS are very proactive regarding in-home asthma outreach.  The 10 programs provide in-home environmental inspections that assist residents in identifying many  risk situations including fire safety,  carbon monoxide poisoning, smoking cessation, air quality and much more.

We take note of how many asthmatics are in a home and ask questions regarding the home environment (mice, rats, roaches, mold, pets, sleep in room with pets?) and we ask about the asthmatic's recent history of attacks in the last three months, dr. visits in that time period due to asthma, hospitalizations, ER visits, days of school or work missed and family days of school/work missed in that time period.  We ask about whether or not the astmatic is a smoker or lives with a smoker who smokes in the home.  Questions are asked about whether or not the asthmatic has a physician and healh insurance.  Does this person have: quick relief meds, a controller med, how many times used last week, is ashtma controlled?, use a peak flow meter? has a written plan?, knows early warning signs of attack, knows triggers, knows how to reduce triggers, etc.

Our Niagara County program provides asthmatics with dust mite barrier bedding that we receive from one of our community partners.

This program has been successful in reducing asthma attacks.  The 10 HNPs in NYS just received the EPA National Leadership Award in Asthma Management for 2011.  When revisits are done 1 year and 2 years later, the numbers of attacks, ER & hospital visits, and days missed are less and most of the asthmatics by then have a doctor, a plan and controller meds.  It is very encouraging.

Feel free to contact me for more information.

Theresa M. McCabe, ( theresa.mccabe@niagaracounty.com)

Supervisor & Public Health Educator

Niagara County DOH, Healthy Neighborhoods Program

Pardon my somewhat late interjection, but I'm really quite intrigued at
this home visit initiative. What may I ask is all of this anyway? Does
the asthma alliance of Indianapolis come to your home to clean
designated areas or do they examine allergen prone areas? Regardless of
what the answer is, I think it's a phenomenal idea. I haven't yet heard
of such an evaluation program, so I would certainly like to see if my
county can implement one. I don't entirely know the logistics or details
of how one gets asthma, but I would think asthma would be detrimental
to ANYONE -- especially if they have or develop a lung related issue
like lung cancer or emphysema. It's dangerous! The more issues that can
be avoided, the better! Would anyone happen to know if iu health has
such a program and if they would be able to provide advice to
asthmatics. Thanks so much! :)

Dr. Goldstein:  Partners for Asthma Action, here in Minneapolis/St. Paul, has over six years of experience with asthma-related home-based environmental assessments and modifications.  We have collected a wealth of evaluation data, including parent reported school absenteeism, health care utilization, symptom burden, prednisone use, etc.  We have also validated this with actual health plan administrative data.  Just this month we released our findings from the health plan adminstrative data and return on investment.  We would be happy to share our evaluation tools, lessons learned, and experiences with IRBs.  We have gone through four IRBs for this type of project, we "have it down".  You can reach me at jill.heins@lungmn.org or 651-223-9578.  Best, Jill Heins Nesvold, American Lung Association in Minnesota

Good to read that the community is taking immense care in making note of all the asthma related stuffs . I have just read the article that you have shared here. Good details have been shared here for all of us

snore doc