Puerto Rico Merck Childhood Asthma Network MCAN Program

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Puerto Rico Merck Childhood Asthma Network (MCAN)
Program
September 2007 Update
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Outline

• La Reds 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

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PR MCAN Program Staff
RAND / UPR
Consultants

• Herman Mitchell, PhD (ICAS)
• Vicki Legion, MPH, Yes We Can
• Sara González (Puerto Rico Lung Association)

• Marielena Lara, MD, MPH (PI/RAND)
• Gilberto Ramos Valencia, PhD (PI/UPR)
• Jesús González Gavillán, PhD (Co-PI/UPR)
• Carmen Arabía Rojas, MPH(Program Coordinator)
• Clara Capo, BA, Nurse Coordinator
• Beatriz Morales, BA (Research Assistant)
• Fernando López Malpica (Investigator/UPR)

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• La Reds Team MCAN Site Visit 2007

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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

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Overview of La Reds 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

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Residencial Luis Lloréns Torres, San Juan, PR
(Housing Project 1)
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Residencial Manual A. Pérez, San Juan, PR
(Housing Project 2)
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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 19, 2007
• 63 (104) of children identified to date came to
  clinic
• 96 (100) of children coming to clinic
• were eligible

• All eligible children recruited into the program
• Continued formal endorsement of the San Juan City
  Health Department

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New Patient Recruitment Jan-Aug 2007
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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

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Type and Distribution of Patient
EncountersJan-Aug 2007
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Cumulative Patient Encounters by TypeJan-Aug 2007
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Total Patients Encounter to Date
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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

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Reach of Open AirwaysWave 1, Luis Lloréns Torres
Schools
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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

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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

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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 its
  resident programs
• Police Department
• Local clinic
• Community leaders (both organizations and
  individuals)
• 6 Community residents at large

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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

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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
  
  
  

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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?

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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

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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

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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

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OUR GOAL TO IMPROVE THE QUALITY OF LIFE OF EVERY
CHILD WITH ASTHMA AND HIS OR HER FAMILY IN OUR
COMMUNITIES