Health Care Provider

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.

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.

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.