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Kresge research gauges asthma program’s impact

Research at the Binghamton’s Kresge Center underscores benefits of New York’s Open Airways Program.
Scientific research is stereotyped as an activity characterized by giant leaps — big, “Eureka!” moments that expand our knowledge, save lives or answer life’s most perplexing questions. But research seldom leaps. Mostly, it plods. And its most important contributions are fashioned not out of the heady fiber of all things new and exciting, but out a far more basic cloth — a deeper awareness and understanding of what exists in the world around us.

This real-world, practical approach to research is the strength of Binghamton University’s Roger L. and Mary F. Kresge Center for Nursing Research. The center has carved out an important niche for itself, helping medical institutions and governmental agencies gauge the effectiveness of treatment and intervention programs.

“We made a conscious decision to do program evaluation,” said Gale Spencer, director of the Kresge Center. “Those who conduct research and implement evaluation methods always like to see a practical application of the data. And at the Kresge Center, we know that research can be used in policy-making, which helps to address identified problems in order to create better outcomes.”

A prime example of the kind of evaluative studies conducted by the center involves one of the most serious and common health-related conditions in the country — asthma. Cases of this chronic respiratory disease, which affects more than 20 million people in the United States alone, are on the rise. Already responsible for three times more school absences than any other chronic childhood illness, pediatric asthma has risen from a rate of 40.1 per thousand in 1982 to 74.9 per thousand in 1995, an increase of 86.8 percent. That makes it the most frequently identified chronic disease in children. Because its causes are unknown and there is no cure, managing the disease is of paramount importance.

Open Airways for Schools is an educational program of the American Lung Association offered to asthmatic children, ages 8 through 11, in various elementary schools throughout the nation. The program, which teaches children how to avoid asthma episodes, was developed to help control asthma and its rising medical costs. But until the Kresge Center got involved, little could be definitively said about its effectiveness.

At the request of the American Lung Association of New York and the New York State Education Department, the Kresge Center tested the program’s hypothesis — that structured asthma education would provide children with the tools to manage their asthma. The expectation was that participating students would improve self-management skills, increase self-confidence and feel more empowered in being able to control the effect of asthma on their daily activities. Open Airways also was seen as a way to stem the tide of low-income families using hospital emergency room visits to manage their children’s asthma. Anecdotal evidence suggested the program worked, but by the mid-1990s no formal study had been conducted.

“When we were first approached to evaluate the program, we did the study because it hadn’t been evaluated before,” Spencer said. “I can’t tell you how many school nurses and administrators had been offering positive feedback, but no one could say with any scientific certainty if it really worked.”

The first Kresge survey helped to definitively and affirmatively answer that question. It included 40 schools from districts throughout the state. Questionnaires went to students, parents and school nurses. Was the program helping children manage their asthma symptoms and their feelings about asthma? Was it educating parents on how to effectively help their children manage asthma? The answer to both questions was a resounding yes, Spencer said.

“Our study showed Open Airways was effective in improving children’s asthma self-management and their feelings about having asthma. It also showed a significant decrease in the percentage of parents reporting emergency room visits and hospital stays,” she said. “And our findings were supported by similar reports from nurses assigned to the schools that participated in the program.”

School nurses also reported a significant decrease in student absences and their belief that Open Airways was a useful program, underscoring the benefits it had in reducing the need for emergency and other healthcare services.

The data gathered by the Kresge Center prompted a follow-up study to measure the program’s lasting value. In 1999-2000, a second Kresge survey evaluated the long-term benefits of the Open Airways program taught during the 1997-98 school year. Children, diagnosed with asthma in the third, fourth and fifth grades, who had participated in the original study, were asked to complete a second questionnaire. The follow-up study also showed that Open Airways was effective.

“While there was some slide backwards, there was no significant difference between the results of the first and second study, so we were able to recommend that the American Lung Association also develop a program for middle school students,” Spencer said.

Ultimately, the success of New York’s Open Airways program can be attributed to the unique collaboration between the American Lung Association of New York, the state education department and the Kresge Center for its research methodology and data analysis expertise, Spencer said.

“The findings from evaluation studies such as this are used to underscore the benefits provided to children in the program and to support the use of such effective intervention programs throughout New York and the nation,” she said.
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Last Updated: 10/14/08