AsthmaCommunityNetwork.org

Health Care Provider

Urban Health Plan(UHP)

Winner Blurb: 

Urban Health Plan (UHP) is a network of nine community health centers and nine school-based health centers located in the South Bronx, NY—the poorest congressional district in the country—and in Corona, Queens, NY. Located within UHP’s catchment area, in Hunts Point, Bronx, is the largest food distribution center in the country. As a result of the traffic and pollution generated by the trucks used to distribute food, Hunts Point has one of the highest asthma rates in New York City. Due to the incidence and prevalence of asthma in this area, and because many of UHP’s patients are unaware that they have asthma, early diagnosis is critical. By integrating asthma care into primary care, all patients are screened for asthma every 6 months, including those with no history of asthma. In 2009, 1,000 patients were screened and 22 percent were diagnosed with asthma.

Asthma Relief Street, UHP’s asthma management program, cares for more than 12,000 people with asthma using a multidisciplinary program that is fully integrated into its primary care practice. The primary care provider, health educator and medical assistant (MA) work closely with UHP’s allergists, pulmonologists, social service workers and the integrated pest management program, as well as with New York City Asthma Intervention and Relief (a.i.r. nyc), to provide integrated health care services.

UHP has created long-lasting relationships with community organizations and has partnered with local hospitals and the neighborhood’s shelters to provide support and asthma education to their constituencies. UHP works closely with the New York City Department of Health’s New York City Asthma Partnership, a citywide coalition that brings together more than 400 community-based organizations and individuals to make recommendations to improve citywide policies and systems that affect people with asthma. This partnership is coordinated by the New York City Asthma Initiative.

UHP has developed a unique workflow algorithm to help identify patients and optimize appropriate treatment and followup. Any patient who visits UHP for primary health care services, whether he or she is an asthma patient or not, meets with an MA who ask a series of questions about asthma and asthma risks, following UHP’s asthma template or asthma-screening template. This visit with the MA is followed by a visit with the primary care provider, who reviews the patient’s responses to the MA’s questions about signs and symptoms and the Asthma Control Test, focusing on medication use; reviews and updates the patient’s Asthma Action Plan as needed; and answers any patient questions. Following the visit with the provider, a health educator holds a counseling session with the patient and reviews five asthma lesson plans: (1) definition of asthma (2) the signs symptoms of exacerbations (3) recommendations on remediation in the home to address environmental triggers (4) differences between "controller" and "rescue" medications (5) and understanding of spirometry and exhaled nitric oxide. Health educators also address any concerns the patient might have about asthma management. This process is repeated during all visits.

UHP’s goal is to empower patients and families to better manage their illness, so patients are encouraged to set self-management goals with the asthma health educator. The five-lesson asthma curriculum, which was developed by UHP clinicians, is used to educate both patients and their families. Using a self-management tool box that includes placebo medications, spacers, peak flow meters, masks, and sample Asthma Action Plans (AAPs), the health educator provides hands-on demonstrations on how to use the metered dose inhalers, dry powdered inhalers and nebulizers. Through an arrangement with various vendors, nebulizer compressors and aerochambers are provided to patients who need this equipment for treatment at home. This allows the health educator to provide hands-on demonstrations on how to use the machine and to provide cleaning and storage instructions to patients.

As of December 2015—

  • 89 percent of UHP’s patients have had a severity assessment.
  • 99 percent of patients with a severity assessment of “persistent asthma” are treated with anti inflammatory medications.
  • 50 percent of UHP’s patients have documented self-management goals.
  • 56 percent of UHP’s patients receive the influenza vaccine each year.
  • 3 percent of UHP’s patients had urgent care or emergency department visits in the previous 6 months and an average of 11 symptom-free days and 0.156 work/school days lost per month.
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The Urban Health Plan Asthma team: Back row: Caridad Taura, health educator; Samuel DeLeon, MD, Chief Medical Officer and Senior Vice President for Medical Affairs. Front row: Health educators Grace Baez, Vanessa Montanez and Kelly Chacon; Acklema Mohammad, MD, Chair, Pediatrics and asthma physician champion; Christine Torres, health educator.
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The Le Bonheur Children’s Hospital

Winner Blurb: 

The Le Bonheur Children’s Hospital’s CHAMP Program (Changing High-Risk Asthma in Memphis through Partnership) is a collaborative that serves children ages 2–18 in Memphis, Shelby County, Tennessee, who are identified as having high-risk asthma. Of CHAMP’s patients, 95 percent are African American children who suffer from poorly controlled asthma that results in preventable hospital and emergency department (ED) encounters, missed school days, and diminished quality of life.

 

Asthma affects up to 13.5 percent of children in Memphis, and it is the cause of 40 percent of Le Bonheur Children’s Hospital admissions. According to the 2010 Tennessee Discharge Data Set, almost 4,000 children were seen in emergency rooms in Shelby County for asthma-related problems. More than 600 of these children had multiple ED visits or hospitalizations, and nearly 200 required intensive care unit admissions. Pediatric asthma hospitalizations cost the Tennessee Medicaid system (TennCare) $2.1 million in avoidable hospitalizations, and an additional $2.6 million for ED visits.

 

The CHAMP Program—which is funded by the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS)*—serves a subset of these patients, focusing on children who are most at risk for multiple or severe asthma exacerbations that would result in unplanned medical encounters, particularly those that take place in the ED or in the hospital (admission or observation). Although CHAMP patients have all been assigned a primary care physician (PCP), many lack a connection with their PCP, or do not consult the PCP for asthma episodes. They primarily live in rental properties characterized by environmental hazards—such as mold, mildew and cockroaches—that exacerbate asthma episodes, and many of them move frequently or spend significant periods of time in more than one residence over the course of a week or month.

 

CHAMP’s theory of change relies on an understanding that asthma care typically is not well managed as a result of several factors: the delivery system is fragmented; providers are unable to share information; and efforts to provide ongoing education, environmental improvements and social supports that will encourage self-management are unfocused. Building on that understanding, CHAMP created an Asthma Registry that includes medical encounter data from TennCare and medical data from electronic medical records. The CHAMP team comprises sub-specialist medical providers with significant experience in using the National Institute of Health’s guidelines for asthma diagnosis and management. CHAMP’s community-based staff members work to educate families and address barriers to self-management. Environmental concerns for at-risk patients are addressed through partnerships with families, schools, PCPs and programs/services. In addition a 24/7 call line is staffed by emergency medical technicians and registered nurses.

CHAMP’s various program components work in an integrated fashion to achieve its ambitious goals. CHAMP seeks to reduce asthma deaths among its target population to zero by June 15, 2015. In addition, the program aims to cut ED visits, avoidable hospitalizations and urgent care visits by 15 percent by June 30, 2015. By that same date, CHAMP also seeks to improve the quality of life for 80 percent of the patients, achieve an overall positive patient/family rating of the CHAMP program from at least 95 percent of the patients/families surveyed, and lower overall health care costs for children served by more than $4 million.

 

A distinguishing CHAMP feature is its Web-based asthma registry for high-risk patients, developed with the technological expertise of the University of Tennessee Health Science Center’s Division of Biomedical Informatics. The registry is a means of compiling and storing key pieces of information that pertain to the 55 data elements forming the core of the CHAMP quality metrics. The registry’s unique feature is that the TennCare administration allows the program to download an updated listing of all CHAMP patient encounters each month, including cost data. When CHAMP patients sign the institutional review board informed consent form, they allow the program to receive 1.5 years of TennCare medical-encounter data prior to enrollment and monthly updates every month after enrollment. This information furnishes an opportunity to use the registry as a case management tool, complete with warnings and automatic notifications that prompt CHAMP to contact families and provide help when, for example, prescriptions are not filled.

 

The most current data—covering the quarter ending December 31, 2014—show that the program’s 464 enrollees have seen significant gains in their asthma management. There was a 30-percent reduction (from baseline utilization) in the percentage of children who experienced at least one ED or urgent care visit per quarter. There was a 42-percent reduction in the percentage of children who have had at least one ED or urgent care visit for asthma in a 6-month period, and there was a 40-percent reduction in the percentage of children hospitalized each quarter for asthma-related diagnoses. With regard to possible reductions in cost of care, at the close of the 10th quarter, the average cost of care for each CHAMP patient per year was 52 percent less than it had been 1 year prior to CHAMP enrollment.  

 

Among CHAMP’s many accomplishments to date, the CHAMP Medical Director and Asthma Care Coordinators provided basic asthma education courses for all school nurses in the Shelby County system over a 2-year period (in 2013 and 2014). As for the environmental conditions of children with asthma and their families, CHAMP employs individual family interventions and collaboration with community partners to improve completing renovations and addressing concerns with laws, codes and community policies. Although still being refined, CHAMP shows great promise for meeting and exceeding the stated goals of its CMS-funded collaborative agreement.

 

*CHAMP is supported by Grant number 1C1CMS331046-01-00 from the Department of Health and Human Services, Centers for Medicare and Medicaid Services.  The contents of this document are solely the responsibility of Le Bonheur Children’s Hospital, Division of Community Health and Well Being and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

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1st row – Christina Watkins-Bolden, Alexandria Bagley, Teresa Hughes, Dr. Christie Michael, Susan Steppe, Stephanie Watson, Linda Mallory, and Mark Sakauye 2nd Row – Regina Perry, Yvonne Elliott, Dr. Dennis Stokes, Raisha Montgomery, Karen Nellis, and Kelli Holloway 3rd Row - Dr. Christina Underhill, Beverly Brown, Tabatha Johnson, and Emin Kuscu
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Tufts Medical Center

Winner Blurb: 

Tufts Medical Center (Tufts MC) is a not-for-profit academic medical center that provides health care to patients both locally in the City of Boston, Massachusetts, and regionally in surrounding communities. For the past eight years, Tufts MC's Department of Community Health Improvement Programs (CHIP) has operated the Asthma Prevention and Management Initiative (APMI) to serve a primarily immigrant, non- or limited-English speaking and densely populated Chinatown community. APMI is the only local asthma management program that focuses on and prioritizes Asian speaking families and features program components in the hospital, schools and community.

Tufts Medical Center established the APMI in 2006, in partnership with Chinatown school principals. Asthma prevalence had increased from 15 to 20 percent at the local elementary school that year (compared to a 10 percent prevalence in Boston as a whole) and Tufts MC's bilingual pediatric providers saw a spike in asthma-related urgent care visits. In response, the CHIP team set out to inform the community in places where people live, work, and gather - at day cares, elementary and secondary schools and community agencies - and educate patients and families during home visits to children with poorly controlled asthma.

In 2006, CHIP secured a Health Disparities Grant from Blue Cross Blue Shield Foundation and used the funding to initiate and sustain APMI for three years. Additional grant support from a local community development fund, The Chinatown Trust Fund, and the Department of Housing and Urban Development through the Boston Public Health Commission (BPHC), facilitated APMI's expansion to include home visits and to serve more families over time. In partnership with local elementary and secondary school principals, school nurses, Tufts MC administrators and physician champions, the CHIP director established APMI and hired its first program manager in 2006 and a bilingual Community Health Worker (CHW) in 2011. Based on a detailed assessment, conducted with input from parents with limited English skills, teachers and clinical providers, APMI developed targeted solutions for Chinatown's asthma improvement needs.

APMI developed multilingual, multimedia asthma education and self-empowerment materials that are distributed in the clinic, at schools, during home visits and in the community. In partnership with the local schools, APMI created asthma education classes and an asthma education program for local day care and community center staff, and began the development of an asthma registry connected to Tufts MC's electronic medical record system. In addition, APMI convened care providers from across the pediatric continuum - emergency, inpatient and outpatient departments, as well as local schools - to develop standardized messaging, materials and procedures to ensure children with asthma and their families hear consistent asthma care messages everywhere they receive care.

APMI also promotes prevention of asthma and improved asthma management across local neighborhoods by providing all students diagnosed with asthma, whose parents consent to their involvement, with education programs at local elementary and middle schools. APMI promotes community awareness and management of asthma, particularly how to recognize environmental triggers, by educating local parents and day care, preschool and elementary school staff in Chinatown.

Children with poorly controlled asthma who are referred to the Asthma Prevention and Management Initiative by their primary care physicians or identified by APMI staff from data in the asthma registry, receive asthma action plans and tailored and culturally and linguistically competent environmental home visits and supplies, provided by the Boston Public Health Commission. APMI currently serves more than 100 families per year through the home visit program, which includes environmental assessments, medication review, review of asthma action plans and disease education for children and their families.

APMI's home visit program is part of the broader Boston Asthma Home Visit Collaborative (BAHVC). APMI draws on and contributes to the city-wide standardized approach to in-home asthma care. Where appropriate, APMI's Community Health Worker and other home visitors make referrals to Boston's Breathe Easy at Home program - an extension of the BAHVC - for housing inspection and advocacy on behalf of tenants, and refer patients to other services to reduce environmental and social stressors, as appropriate.

To complete the circle of care and ensure communication, home visitors fill out a Home Visit Progress Note and submit it to referring clinicians after each home visit. The note also is incorporated in Tufts Medical Center's ambulatory electronic medical record and listed as a patient encounter, thus enabling clinicians to review home visit findings and reinforce CHW and home visitor interventions with patients during clinical visits. As part of the BAHVC program, APMI home visitors also share de-identified home visit information with the BPHC.

APMI tracks its progress and impact in the schools, clinic and community. After four years of delivering asthma education in schools, absences for students with asthma decreased by one day, while absences for the general elementary student population decreased by only 0.2 days. Efforts to improve clinician adherence to National Institutes of Health EPR-3 Guidelines for Asthma Care also showed impressive results. Chart review data indicate that 35 percent more children, with two or more asthma-related urgent care visits within an eight-week period, now receive appropriate controller medication prescriptions than before the clinical quality improvement effort began. For children with poorly controlled asthma, APMI can demonstrate statistically significant improvements in the home environment (i.e. reduction in the presence of triggers) and asthma outcomes (i.e. improved ACT scores, decreased hospital admissions and increased use of asthma action plans) from the first to the follow-up visit, which occurs six months later.

A partnership with BPHC's Asthma program since its inception has aided APMI's sustainability. With BPHC's encouragement and the Department of Housing and Urban Development award, APMI was able to initiate its home visiting program, which Tufts MC continues to fund. APMI also is active in advocacy efforts in Massachusetts, supporting reimbursement for asthma education and home visits by third-party payers. APMI has strong data to support this case; Outcomes data from 2009-2013 show that receiving home visits decreased urgent care visits by 21 percent and inpatient admissions by six percent, saving the health care system nearly $50,000 in avoided costs.

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From left to right: May Chin RN, Program Manager, Asthma Prevention and Management Initiative Sherry Dong, Director, Community Health Improvement Programs, Lynne Karlson MD, Division Chief, General Pediatrics and Adolescent Medicine, Sue Chin Ponte,RN NP, Director, Asian Clinical Services, Zifeng (Maple) Zou, Community Health Worker, Asthma Prevention and Management Initiative
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Parkview Health System (Asthma Education and Management Program)

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Parkview Health System is a nonprofit health care provider that delivers care to more than 875,000 people in a five-county area in northeast Indiana. Parkview’s community consists of urban, suburban and rural populations that have seen increasing asthma prevalence over the past 15 years. In response to data indicating that asthma is a frequent cause for emergency health care services, particularly among low-income communities served by Parkview, as well as input from community partners, the hospital developed a comprehensive Asthma Education and Management Program in 2004.

Parkview’s Asthma Education and Management Program identifies children and adults with asthma and improves their ability to self-manage by providing support services, resources and age-appropriate education. The program is run by the hospital’s Integrated Community Nursing Program and relies on Parkview’s partnerships with local school districts and social service agencies to enroll patients and deliver program services. Parkview also partners with the Fort Wayne-Allen County Department of Health and Indiana State Department of Health (ISDH) to provide environmental home visits and to evaluate the Asthma Education and Management Program’s impact. With its partners, Parkview also educates school staff, including school nurses, teachers, coaches and bus drivers on the signs and symptoms of asthma and instruction on how to address a severe asthma attack. Parkview also works with the county’s Healthy Homes Program to provide environmental home visits and in-home asthma/allergy education.

One important program component is the Emergency Department (ED) Asthma Call Back Program, which began in 2009 and serves over 1,200 individuals annually. The Call Back Program equips people who have visited the ED with the knowledge and tools they need to manage their asthma and avoid future ED visits. All patients who visit the ED for asthma-related illnesses receive calls from an asthma educator after they are discharged to discuss asthma control and access to and appropriate use of medications. Where indicated, nurses can order home visits to provide environmental asthma trigger assessment and mitigation. Home visitors typically provide supplies, including bedding encasements, HEPA vacuums and green cleaning supplies, at no-cost, and they provide asthma education. Qualified patients who cannot afford their asthma medications or do not have a medical home are enrolled in Parkview’s Medication Assistance Program and referred to a physician in the Parkview system, a federally qualified health clinic, or a free clinic.

Through its partnership with ISDH, Parkview has access to evaluation data that demonstrate the impact of its asthma program. Surveillance data show improved asthma outcomes over time in counties served by Parkview as compared to demographically similar counties within the state. ISDH’s evaluation of the ED Call Back Program found that it is effective at reducing ED readmissions: ED recidivism dropped to 15.04 percent in the intervention group compared to 21.95 percent in the baseline group. The ED Asthma Call Back Program also demonstrated an impact on school and work attendance and quality of life, with nearly 59 percent of participants reporting they had missed zero school or work days since involvement in the program. The program has also demonstrated a positive impact on increasing access to medical homes and controller medication with 11.2 percent of participants acting on physician referrals and 16.4 percent receiving prescription support services. Finally, Parkview’s own data demonstrate a reduction in inpatient visits for asthma over time and reduced average costs per patient encounter. Parkview has been able to demonstrate a steadily improving return on investment (ROI) from the ED Asthma Call Back Program – from $20 saved for every $1 invested in the baseline year to $23.75 saved per dollar invested in 2012. These ROI data helped Parkview’s leadership decide to expand the ED Asthma Call Back Program to all six campuses within the health system.

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Pictured l-r: Deb Lulling and Jan Moore
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Greenville Health System’s Pediatric Asthma Action Team

Winner Blurb: 

The Center for Pediatric Medicine (CPM) with the Greenville Health System Children’s Hospital is the major clinical provider of outpatient care for children with limited health care access in Greenville, South Carolina. A diverse community, Greenville is South Carolina’s most populous county and asthma/bronchitis is the leading cause of hospitalization for children under 18 in the area. Ninety percent of the population served at CPM receives Medicaid funding.

The Asthma Action Team (AAT) is a multidisciplinary, multilingual, family-centered program that was formed in 2008 to address increasing asthma prevalence, increasing pediatric emergency department (ED) visits and hospitalizations and ED recidivism for asthma, and growing asthma disparities in greater Greenville. The AAT is staffed by pediatricians, certified asthma educators, respiratory therapists, case managers, nurses, social workers, translators, an electronic medical record (EMR) technician, and community home visitors. Residents training in pediatrics, internal medicine, family practice and third and fourth year medical students also rotate through the AAT clinic where they learn an evidence-based approach to asthma care according to the National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma.

The program strives to ensure that patients and families receive consistent asthma education and support services in clinics, homes, schools and daycares, including support for environmental asthma control, in order to promote effective self-management and avoid emergency health care utilization. The AAT coordinates with payers, local schools, community-based organizations and others to identify patients in need and to provide case management for children and adolescents with hard to control asthma. Case management includes asthma education, home visits, office visit coordination and school visits with a certified asthma educator from CPM serving as the case manager.

All AAT patients receive personalized pictorial asthma action plans written in their primary language which AAT staff review and update at every patient interaction and share with providers across the Greenville Health System (GHS) network and with school and daycare providers. The action plans are stored in the patients’ EMR and on a web-based platform where clinical providers and educators working across both inpatient and outpatient settings can access and update them. The AAT also maintains a registry and alert system to help manage 4,338 pediatric patients with asthma, to track their asthma outcomes in real time, to stratify patients for care and to ensure high quality and appropriate care is consistently delivered.

The AAT focuses on delivering comprehensive and guidelines-based clinical and environmental care everywhere people with asthma spend time. The team is acutely aware of the social, economic and cultural factors that affect pediatric asthma outcomes for the diverse community GHS serves. To help children with asthma and their family’s access appropriate clinical care and avoid emergency health care use, CPM offers extended evening and weekend hours, same day service to children experiencing asthma exacerbations, and an after-hours telephone triage line. The AAT also partners extensively to provide education, diagnostics, in-home services and social supports for environmental interventions in the community. Partners include the Family Connection of South Carolina’s Project Breathe Easy (PBE), the South Carolina Asthma Alliance, the Greenville Pediatric Asthma Community Collaborative, the Greenville County Schools and many others.

Perhaps the strongest evidence of the AAT’s impact is the fact that at the same time that the population of children with asthma in the CPM system grew by an annual rate of 63 percent, rates of ED visits for asthma declined. Data from the AAT’s partnership with PBE – which applies only to AAT clients who receive referrals to PBE – demonstrate a 71 percent decrease in urgent health care utilization, a 21 percent decrease in unscheduled clinical care visits, a 51 percent decrease in missed school days, and a 41 percent decrease in missed work days for parents post-intervention.

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[Pictured left of sign] l-r: Tom Moran, Jane Teague, Karla Mora, Dr. Josh Henry, Dr. Andrew Wilt, Katy Smathers, Tiffany Timms [Pictured right of sign] l-r: Dr. April Buchanan, Dr. Jill Golden, Dr. Lochrane Grant, Joann Wilson, Rita Rivera, Kristi Caballero, Cindy Garnett, Dr. Amanda O’Kelly, Dr. Cari Sanders, Cheryl Kimble, Debra Powers, Pam Kruzan, Dr. Elizabeth Shirley
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Mission Children's Hospital Regional Asthma Disease Management Program

Winner Blurb: 

Mission Children’s Hospital serves the 21 most rural and isolated counties in North Carolina. This area’s  diverse minority population faces some of the greatest health disparities in the state, and further, the majorty of Mission Children’s Hopsital patients are uninsured or underinsured. Pediatric asthma, unsurprisingly, is one of these disparate health concerns.

Through an innovative and bold approach designed to meet the unique needs of this population and to impact minority children suffering from asthma in a significant way, Mission  Hospital developed the Regional Asthma Disease Management Program (RADMP). 

RADMP confronts these issues at the root of the problem — taking the clinical approach to asthma management and control into non-clinical settings, such as homes, schools and other care facilities in outlying areas. The program addresses social determinants of health, medical and environmental management, education on asthma and environmental triggers, and comprehensive care through an ever-expanding network of invested stakeholders and agencies.

In order to reach minority and low-literacy populations, RADMP utilizes population specific outreach materials and interpretive services. For low-income families, the program offers access through Mission’s Medication Assistance Program for asthma medications. Home remediation to eliminate environmental exposures is provided through RADMP’s strong network of community partners.

In 2008, the program was recognized as one of the state’s top three asthma disease management programs. In 2009, RADMP received a two-year demonstration project grant from the National Heart, Lung, and Blood Institute (NHLBI), as part of the National Asthma Control Initiative. Since 2009, RADMP activities have contributed to reducing asthma-related emergency room visits by 94 percent and hospitalizations by 95 percent, equaling a total savings of more than $800,000. In addition, the average number of school days missed by children in the program decreased from 17 to nine, indicating an increased quality of life. Statistically significant improvements were made in clinical measures including lung spirometry and eosinophilic inflammation.

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Pictured l-r: Don Russell, M.D., Supervising Physician; Shawn Henderson, Practice Manager, Mission Children’s Hospital; Melinda Shuler, Regional Clinical Coordinator/Principal Investigator ; Amy Trees, Case Manager; Helen Thingvoll, Office Specialist
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South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center

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In New York’s South Bronx community, one in five school-aged children has asthma — one of the highest rates in New York City. In response to this staggering statistic, Bronx-Lebanon Hospital Center’s Department of Pediatrics created the Childhood Asthma Management Program in 2000. Through clinical pediatric asthma services, community-based activities of the New York State Department of Health-funded asthma coalition, and hospital-community collaborative programming, the program promotes asthma-friendly environments and ensures the delivery of integrated health care services for children with asthma. 

Early on, program staff members recognized that to improve asthma outcomes, they must not only improve provider knowledge and communication, but also strengthen the existing health system in which providers practice. As a result, the program conducts provider training sessions that translate asthma management recommendations into quality clinical practice to ensure that patients receive comprehensive asthma services across the care continuum. Furthermore, the program engages Medicaid to provide reimbursement incentives for provider participation in asthma education. 

As the lead organization of the South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center also partners with a variety of environmental agencies and community organizations to create tailored environmental interventions that address both indoor and outdoor asthma triggers. Program partners provide building walk-throughs, designate asthma-friendly zones at schools, and provide pest management assistance and air-sampling. In addition, the program distributes culturally appropriate and literacy-sensitive educational materials throughout the hospital and the community to promote patient self-management and encourage healthy behaviors in homes.

This multi-faceted approach to asthma care has resulted in tremendous success. Since 2003, Bronx- Lebanon Hospital Center has shown a 42 percent decrease in asthma-related hospitalizations, as well as a decrease in the length of stay of asthma-related hospitalizations. This equates to an annual average cost savings of about $431 per child. In addition, the National Asthma Control Initiative recently named the Bronx Lebanon partnership as a clinical champion in recognition of their efforts in promoting the Expert Panel Report 3 – Guidelines for the Diagnosis and Management of Asthma.

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Mike Flynn, Director, Office of Radiation and Indoor Air and Gina McCarthy, then Assistant Administrator, Office of Air and Radiation, U.S. EPA, present Award to Lauren Brown, Alexandra Meis, Dr. Mamta Reddy, Tomas Jimenez, Diane Strom and Evelyn Arguinzoni of the South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center
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Children's Mercy Hospitals and Clinics

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Children's Mercy Hospitals and Clinics — serving families in Nebraska, Oklahoma, Kansas, and Missouri — uses a creative approach for managing pediatric asthma. Children's Mercy trained a team of asthma educators to implement a three-part environmental asthma management program that included education for providers and staff; personalized case management and education for families with high hospital utilization due to asthma; and in-home, school, and day care environmental assessments to determine the presence of asthma triggers. Children's Mercy determined that for those patients with severe cases of asthma, home-based, hands-on education about the common environmental asthma triggers was critical to ensuring that patients gained control over their asthma and made the connection between their asthma symptoms and environmental triggers in their home environment. During the home assessments, Children's Mercy staff conducts a comprehensive environmental and safety assessment that identifies common environmental asthma triggers. Based on the home assessments, asthma educators provide personalized environmental health action plans to help patients and their families identify their asthma triggers and to reduce these triggers in their home. Through a creative partnership with the Healthy Homes Network for Kansas City, and funded by a HUD Healthy Homes Demonstration grant, qualifying families are provided up to $2,000 worth of home supplies and repairs to try to reduce environmental asthma triggers. As a result of Children's Mercy's efforts, patients and their families know more about what triggers their asthma and how to control asthma symptoms. Children's Mercy has seen fewer emergency department visits and hospitalizations since the program's inception.

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Jeff Holmstead, then Assistant Administrator, Office of Air and Radiation, EPA, presents Award to the Children’s Mercy Hospitals and Clinics
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IMPACT DC

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Improving Pediatric Asthma Care in the District of Columbia (IMPACT DC) Asthma Clinic targets inner-city, minority and disadvantaged children who suffer disproportionate asthma morbidity and mortality. Most live with challenging social and environmental circumstances with daily exposure to multiple asthma triggers. Their families often have a tenuous connection with their primary care providers, and thus frequently rely on emergency departments (EDs) for asthma care. While EDs typically provide excellent episodic care for acute asthma exacerbations, they usually pay little attention to longitudinal management issues. As a result, many families view asthma as an episodic problem instead of a chronic disease requiring daily management. IMPACT DC's fully validated program recruits from a large urban ED (Children's National Medical Center) and focuses on three distinct domains: environmental control, medical management, and longitudinal care. In a prospective clinical trial, it improved multiple patient outcomes. It is an innovative, replicable, and cost-efficient national model for asthma mitigation among children in the inner city.

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Pictured l-r: Abisola Ayodeji, Beth Dunbar, Jordan Schmidt, Dr. Radha Chirumamilla, Alicia Newcomer, Deborah Quint, Dr. Stephen Teach, and Terry Ahern of IMPACT DC
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MaineHealth AH!

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MaineHealth's service area covers 90,675 patients with asthma, including 27,156 children in southern, central, and western Maine. The AH! (Asthma Health) Program combines standards-based clinical care with robust indoor and outdoor environmental asthma management. Patients receive counseling to manage exposures to environmental triggers in home, school and work settings. The AH! Program has a strong presence outside its clinical settings, having built long-term relationships with community organizations, schools and daycare centers, public health departments, and others. The AH! Program also takes leadership positions to advocate for municipal, state, or national public policy actions—such as bans on tobacco use in public places—that create asthma-friendly environments. The results of these impressive efforts have reduced emergency room use, hospitalizations, and missed school and work days, and improved physician adherence to national guidelines for asthma care. Evaluations at six months post-intervention show a 61 percent reduction in appropriate emergency room use and a 29 percent reduction in hospitalizations. Maine Medical Center, one of MaineHealth's member hospitals, achieved a reduction in emergency room visits from 81 percent to 20 percent and hospitalizations from 32 percent to 3 percent. These improved outcomes resulted in 2006 avoided costs of $61,635 on emergency room visits and $411,470 on hospitalizations.

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Elizabeth Cotsworth, then Director, Office of Radiation and Indoor Air, U.S. EPA, presents Award to (from left to right) Donna Levi, Julie Osgood (holding the award), and Rhonda Vosmus of MaineHealth AH!
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