Overview Committee RAND_ UPR_ MCAN_ Other

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					Puerto Rico Merck Childhood Asthma
     Network (MCAN) Program
       September 2007 Update
          Outline
• La Red’s partners and staff
• Program goals and objectives
• Accomplishments to date
• Major challenges and successful
  strategies to address them
• Plans for the rest of 2007
• Translational research design and
  evaluation
• Review of baseline data findings
   PR MCAN Program Staff
RAND / UPR                            Consultants
– Marielena Lara, MD, MPH (PI/RAND) • Herman Mitchell, PhD (ICAS)

– Gilberto Ramos Valencia, PhD        • Vicki Legion, MPH, Yes We Can
  (PI/UPR)
                                      • Sara González (Puerto Rico
– Jesús González Gavillán, PhD (Co-     Lung Association)
  PI/UPR)

– Carmen Arabía Rojas, MPH
  (Program Coordinator)
– Clara Capo, BA, Nurse Coordinator
– Beatriz Morales, BA (Research
  Assistant)
– Fernando López Malpica
  (Investigator/UPR)
La Red’s Team – MCAN Site Visit 2007
Overall Goals of the Puerto Rico
  MCAN Program (“La Red”)


                • Improve realized access to
                  and quality of asthma health
                  care services for children
                • Make schools more asthma-
                  friendly
                • Promote asthma-safe home
                  environments
                • Promote linkages of key
                  stakeholders and integration
                  of services in the community
                • Be sustainable beyond Merck
                  Funding
Overview of La Red’s Interventions

  • Based on language and cultural adaptation of
    evidence-based models:
        – Yes We Can
        – Inner-City Asthma Study
        – Open Airways
  • Community Asthma Team (CAT) serves as
    integration and coordination focus
  • Targets children with moderate and severe asthma
    in two housing projects in San Juan, Puerto Rico
  • Builds on 4 years of experience with the target
    communities
 Residencial Luis Lloréns Torres,
San Juan, PR (Housing Project #1)
  Residencial Manual A. Pérez,
San Juan, PR (Housing Project #2)
        Accomplishments To Date

• Goal 1: Improve Access To and
  Quality of Asthma Health Care
  Services for Children
   – Yes We Can “immersion” training in
     San Francisco
   – Almost complete adaptation
   – Started local asthma clinic on January        –All eligible children
     19, 2007                                      recruited into the program
      • 63% (104) of children identified to date   –Continued formal
        came to clinic                             endorsement of the San
      • 96% (100) of children coming to clinic     Juan City Health
        were eligible                              Department
                    New Patient Recruitment
                        Jan-Aug 2007


              25




              20




              15


Recruitment


              10




              5




              0
                   January   February   March   April            May   June   July   August
                                                        Months
     Accomplishments To Date

• Goal 2: Promote asthma-safe home
  environments
  – On-site visit consultation by ICAS intervention
    developers with follow-up local trainings
  – Conceptualization of how to scale down
    intervention based on documented allergic risk
    and exposure
  – Translation of ICAS
    materials into Spanish
  – Designing interface
    with Yes We Can
    intervention
Type and Distribution of Patient Encounters
               Jan-Aug 2007


30



25



 20



 15                                                                         Allergy Test
                                                                            1rst home visit completed
                                                                            Came to F/U
 10                                                                         Came to initial Eval.



     5



      0
          January
                    February
                               March
                                       April
                                               May
                                                     June
                                                            July
                                                                   August
Cumulative Patient Encounters by Type
            Jan-Aug 2007

 100

  90

  80

  70

  60

  50
                                                                              Allergy Test
  40                                                                          1rst home visit completed
                                                                              Came to F/U
   30
                                                                              Came to initial Eval.
   20

   10

       0
           January


                     February


                                 March


                                         April



                                                 May



                                                       June



                                                              July



                                                                     August



                                Months
          Total Patients Encounter to Date

               250




               200

                                                                                                Came to initial Eval.

                                                                                                Came to F/U
               150
Participants




                                                                                                1rst home visit completed

                                                                                                Allergy Test

               100




               50




                0
                     January   February   March   April            May   June   July   August
                                                          Months
Accomplishments To Date
 Goal 3: Make schools more asthma-friendly
– 56% (335) of all 4rth (84), 5th
  (64) and 6th (187) graders in
  Housing Project #1 received
  Open Airways
– Conducted 1rst Open
  Airways teacher training
    8 teachers
    4 of 5 schools in Housing
     Project #1
             Reach of Open Airways
       Wave 1, Luis Lloréns Torres Schools


120



100



 80



  60
                                                                                # Participants

                                                                                Target
  40



  20



      0

          Luis Lloréns
             Torres      Rodriguez Cabrero
                                           Martinez Perez de
                                   Schools      Almiroti       Julio J. Henna
  Accomplishments To Date

• Goal 4: Promote linkages of key stakeholders
  and integration of services in the community
  – Island-wide Advisory Board
      15 members, representing 12 organizations
      Meetings May ‟06, Sept ‟06, March „07
  – Luis Lloréns Torres Community Advisory Board
    (CAB)
      20 members, representing 14 organizations and
       community residents
  – Continued networking strategies for building and
    sustaining relationships with community leaders and
    residents in both housing projects
La Red Advisory Board Members
     (in alphabetical order)
  •   American Lung Association
  •   APNI
  •   Glaxo Smith KIine
  •   Island-wide recognized asthma experts
  •   Local philanthropy (Dar Foundation)
  •   Luis Lloréns Torres Housing Project: Central
      Administration, 3 Resident Councils, Local clinic,
      School representative
  •   Manuel A. Perez Housing Project Local Clinic
      Medical Card Systems
  •   Merck Sharp & Dhome
  •   Quality for Business Success
  •   Puerto Rico Department of Education
  •   San Juan Department of Health
Luis Lloréns Torres Community
   Advisory Board Members
 • Representatives from all 5 elementary
   schools (4 attending first meeting)
 • Representative from all 3 Resident Councils
 • Representatives from Housing Project
   Administration (Martinal Properties) and it‟s
   resident programs
 • Police Department
 • Local clinic
 • Community leaders (both organizations and
   individuals)
 • 6 Community residents at large
Accomplishments To Date

• Goal 5: Be sustainable beyond Merck
  Funding
  – Established Sustainability Task Force
  – Hired local sustainability consultant who has
    outlined basic elements of initial sustainability
    plan:
      realistic local sustainability scenarios
      combined grassroots and private sponsors
      Endowment concept
  – Press conferences for increased visibility
Translational Research and
  Implementation Issues

• Difficulty in finding and retaining staff that has
  technical and cultural capacities
• Balancing:
   – Maintaining fidelity of proven interventions
     and what is feasible and acceptable locally
     (How to “criollizar” the interventions?)
   – Interface between IRB requirements with
     local clinic and community members
     access to important information
  Other “Implementation” Issues

• Underestimated resources necessary for ICAS
  adaptation and evaluation
• Recurrent eruptions of community violence
• Upcoming change of political administration in
  the midst of the intervention
• Local limitations in national and “state” long-term
  sources of health care financing
• When and how to transition to the second
  community?
Translational Research Design
• Adaptation and implementation of evidence-based
  interventions (or how to “criollizar”)
    Language and cultural appropriateness
    Tradeoffs between scientific rigor, feasibility
     constraints, and local preferences
• Ongoing feedback from community, experts, and
  important stakeholders via Advisory Boards
Translational Research Design
              (Cont.)

• Baseline - 12 mo post evaluation of child and
  family asthma-related outcomes:
    Reductions in hospitalizations and ED use
    Reductions in symptom burden
• Process evaluation with an eye on
  sustainability and institutionalization
• Plan taking lessons learned from first
  community to second community in San Juan
Plans for September- December 2007


 • Complete “transition” process
 • Complete ICAS intervention for those
   initially recruited starting Jan 2007
 • Continue clinical YES WE CAN
   intervention for recruited patients
 • Second iteration of Open Airways
   intervention this fall
 • Continue documentation of lessons-
   learned from adaptation of evidence-
   based interventions
 • Step-up planning and other efforts of
   Sustainability Task Force
  OUR GOAL: TO IMPROVE THE QUALITY OF
LIFE OF EVERY CHILD WITH ASTHMA AND HIS
   OR HER FAMILY IN OUR COMMUNITIES

				
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