Friedman, A., Lachance, L., Stoll, S., Awad, D., Clark, N.M. Characteristics of Asthma Programs with Positive Health Outcomes. American Academy of Allergy Asthma and Immunology Annual Meeting, San Diego, California, May 2007. Center for Managing Chronic Disease University of Michigan

1. 2634 Characteristics of Asthma Programs with Positive Health Outcomes Friedman AR MPH; Lachance L PhD; Stoll S MPH; Awad D MA; Clark N PhD Center For Managing Chronic Disease, University of Michigan School of Public Health Rationale: To better understand successful asthma programs, the Asthma Health Outcomes Project (AHOP) identified national and international asthma programs (n=500). Programs that included an environmental component and reported a positive impact on asthma-related health outcomes (n=223) were examined to identify factors associated with success. Methods: Through telephone interviews, program documents and published literature, data were gathered on program background, design, and administration, and evaluation design and findings. Descriptive frequencies provided an overall picture of work in the field, and bivariate relationships between programmatic factors and health outcomes were analyzed using X2 statistics and Fisher's exact tests (p<0.05), and unconditional logistic regression. Results: Descriptive data present a snapshot of the current field of asthma programs. For example, strategies most commonly used by surveyed programs included asthma education (96%), home visits (43%), systems change (42%), and clinical quality improvement (37%). Initial findings from bivariate analyses of 111 programs that had evaluation results reported in peer-reviewed publications were grouped into programmatic categories. These findings suggest that programs are more likely to report a positive impact on health outcomes if they: Work with health care providers; Have close ties to communities; Collaborate with others; Follow established steps of program development in order to meet the needs of the community; and are tailored to meet the needs of individual participants, particularly with regard to environmental trigger sensitivity . Conclusions: Preliminary analyses suggest that particular program processes are associated with improving health outcomes. Key descriptors of successful programs are: community centered, clinically connected, and continuously collaborative . Descriptive frequencies were drawn from the 223 surveyed programs that met the inclusion criteria: (1) focused on asthma; (2) included an environmental component (e.g., education about triggers, policy action to reduce trigger exposure); (3) completed an evaluation that showed a positive impact on at least one health outcome. Initial analyses found significant variation in program evaluations. A focused analysis was conducted on programs that reported using randomized controlled trials with evaluation results reported in peer-reviewed publications (n=65). Bivariate relationships between programmatic factors and health outcomes were analyzed with  2 statistics using Fisher's exact tests (p<0.05). ABSTRACT METHODS RESULTS Research funded by grant XA-83042901 from the Indoor Environments Division of the US Environmental Protection Agency Background Planning and Design Implementation Administration Program Context Impact and Sustainability Health Care Utilization Quality of Life Functional Status School/Work Loss Symptoms Lung Function Medication Use Self-Management Skills Use of an Asthma Action Plan Peak Flow Meter Change in Clinical Actions Environmental Outcomes Associated programmatic factors and reported positive health outcomes (n=65): Total Identified Programs n=532 Program Survey Complete n=223 Ineligible n=105 No Evaluation Available n=194 Not surveyed n=10 Not RCT n=46 Evaluation Complete n=233 Eligible n=427 Unpublished n=112 Published n=111 Descriptive Frequencies Educated healthcare providers (including school nurses) Had a component that took place in a doctor’s office/clinic Collaborated with other agencies/organizations on policy action Collaborated with other agencies or institutions Collaborated with governmental agencies Designed their programs to target a particular race or ethnic group Assessed trigger exposure as an environmental strategy Tailored their intervention based on an assessment of trigger sensitivity Had an office located in the target community Improvement to hospitalizations and ED visits Improvement to hospitalizations Improvement to emergency department visits Improvement to emergency department visits Improvement to quality of life for children Improvement to quality of life for parents Improvement to quality of life for adults Improvement to school absences Improvement to school absences and medication use Managing Organization Overall Program Strategies Environmental Triggers Addressed Environmental Strategies B ivariate analysis of associations between programmatic factors and asthma health outcomes: RCT n=65 n=221 n=221-223 n=218-223 n=222-223 Tailored their content or delivery based on individual participants’ health or educational needs Improvement to asthma symptoms and quality of life for adults