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Track
2-5b
Research
Asthma Control and Education (ACE) :
A Model of Cultural Competence for
Latino Inner City Adults
INTRODUCTION: The Asthma Control and Education Program (ACE)
is a collaborative effort to address the problems associated with asthma
management of a primarily Puerto Rican inner city community. The effectiveness
of this program is measured in several outcome areas.
METHODS: This ongoing, prospective two-year study enrolls
all consenting adults with a primary diagnosis of asthma. Assessments
are made at baseline, as well as 3, 6, and 12 months. Each patient undergoes
an initial assessment followed by three educational sessions incorporating
a host of culturally sensitive videos, visual aides and teaching analogies.
In addition, an environmental survey is conducted at each home and appropriate
interventions are recommended. The assessments include health care utilization,
disease management ability, functional status and health-related quality
of life (Health Status Questionnaire , HSQ) , and depression (Center for
Epidemiological Studies - Depression Scale, CES-D).
RESULTS: During the first 9 months, we evaluated 178 patients
at baseline. Ninety (50.6%) are still enrolled. Eighty-eight percent did
not return for follow-up. Seventy-six patients completed the educational
sessions. There was a 47% reduction in Emergency Department utilization,
a 71% reduction in hospital admissions, resulting in an estimated cost
savings of $100,000. Forty-six patients provided complete data sets. The
HSQ score-mental component was 42.2 at baseline and 47.5 at 3-month follow-up
(p<.001); the HSQ score-physical component increased from 29.8 to 39.4
(p<.01). The CES-D scores were mild/moderate (mean-25.04) for 10 of
the patients and severe (mean=30.23) for 23 others. The home environmental
surveys revealed the following environmental risks: exposure to cigarette
smoke (61.8%), gas stoves (50%). and pets (45.2%).
CONCLUSIONS: Preliminary data suggest that a culturally
sensitive disease management approach to asthma significantly impacts
the quality of life of our patients, as well as reducing ED utilization
and hospital admissions. Depression appears to be a significant complicating
factor in this population of patients.
Jane Z. Reardon, MSN, RN, CS and Patricia Hernandez, BSN, RN
Acute Care Nurse Practitioner and ACE Program Coordinator
Hartford Hospital
80 Seymour Street - Dept. of Medicine
Hartford, CT. 06102
(860) 545-2302 Phone
(860) 545-5057 Fax
jreardo@harthosp.org
Jane Reardon is an Acute Care Nurse Practitioner
on a Pulmonary Focused Unit at Hartford Hospital in Connecticut. She holds
a Master's Degree in Nursing from Yale University and is a member of their
Courtesy Faculty. She is active in numerous professional organizations,
including the American Thoracic Society, the Respiratory Nursing Society
and Sigma Theta Tau. She serves on the Board of Directors for the American
Lung Association of Connecticut and the American Association of Cardiovascular
and Pulmonary Rehabilitation, chairing the National Task Force on Racial
and Cultural Diversity for that group. In collaboration with Dr. Scott
Wolf and the Hartford Hospital Research Team, Blue Cross/Blue Shield of
Ct., the Hispanic Health Council and a major pharmaceutical company, she
helped develop the Asthma Control and Education Program (ACE) which targets
high-risk inner city Puerto Rican adults with asthma. Jane has published
a number of articles relating to patient education and Pulmonary Rehabilitation
and has presented at conferences nationally and internationally. NEXT >
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