AsthmaCommunityNetwork.org

Community in Action

Esperanza Community Housing Corporation

Winner Blurb: 

Esperanza Community Housing Corporation (Esperanza) serves the communities located in South Los Angeles, an area that is home to almost one million residents and one of the most economically disenfranchised areas in the County of Los Angeles.  Founded in 1989 out of a successful community organizing campaign to prevent the displacement and housing vulnerability of tenants, Esperanza has grown to become a national leader in advancing the Promotores de Salud (Community Health Promoters)  Model  in targeting health disparities, improving health, and increasing access to health services for community residents.  Since 1995, Esperanza has trained and mobilized 474 Promotores de Salud, through an intensive 6-month training, to provide culturally accessible primary prevention, health education  and advocacy services to families and children in South Los Angeles.  In 1998, Esperanza began cultivating its Healthy Homes collaborative to address primary prevention of lead poisoning and other housing-based hazards,  in a multi-layered approach to mitigating environmental health hazards in the home.  Recognized as a National Healthy Homes Leader, Esperanza established the Healthy Breathing Program which uses a Healthy Homes approach in its home-visitation model to focus on the identification of asthma triggers, iterative health education, and management of asthma episodes in the home.  

 

Along with their team of Promotores, Esperanza’s Healthy Breathing Program partners with federally qualified health centers, local hospitals, and clinics to provide comprehensive services to asthma patients throughout the year.   Esperanza’s Healthy Breathing Program features repeated in-home visits and a year-long patient evaluation; identifies and helps control in-home asthma triggers; and, provides in-depth asthma education for patients, household members, and caregivers.  The program strives to enroll at least 500 pediatric and adult asthma patients every three years.  These efforts have led to improvements in prescription adherence, increases in the number of patients with asthma action plans, reduction in severe asthma episodes, and more efficient referrals to medical homes and wrap-around services.  The Healthy Breathing Program provides valuable cost savings by reducing the number of unnecessary emergency room visits.  A 2012 analysis of a single emergency department saw more than 1.4 million dollars in savings by utilizing preventative in-home and outreach education. 

Winnner Photo: 
Winner Photo Caption: 

Healthy Breathing Team Members (Left to Right): Consuelo Pernia, Destinee DeWalt, Maria Bejarano, Amelia Fay-Berquist and Ashley Lewis.

Award Winner Category: 
Award Year: 

Public Health—Seattle & King County

Winner Blurb: 

During its 20-year history, the King County Asthma Program (KCAP) at Public Health—Seattle & King County has pioneered research and programs in asthma management. Under the guidance of Dr. Jim Krieger, KCAP developed its core programming: home visits with community health workers (CHWs) to reduce asthma triggers in homes and improve asthma outcomes. For 20 years, KCAP’s projects and research have helped build the solid evidence base for this model, which now informs asthma services offered across the nation. To build this program, KCAP program staff have worked with care providers in public health settings, hospital systems, community clinics, health plans, schools, housing agencies and community organizations. Since its original demonstration project began in 1997, KCAP has engaged more than 4,000 patients in programs to manage environmental asthma triggers and improve care delivery for better health outcomes.

 

Building on a deep history of providing asthma services to those most in need, KCAP’s current Guidelines to Practice (G2P) project focuses on coordinating care and services for low-income clients with poorly controlled or uncontrolled asthma, specifically for King County’s African American, Hispanic and Somali communities. These communities are disproportionately affected by asthma and more likely to live in housing that exposes them to asthma triggers. Funded through a grant from the Patient-Centered Outcomes Research Institute (PCORI), G2P is KCAP’s most robust program to date. The program coordinates care between the patient, the patient’s health care provider and the patient’s health plan. Experienced CHWs work with patients in their homes to reduce asthma triggers; they also provide case management, support, supplies and resources to help patients self-manage their asthma. Working with several clinics and health plans, KCAP has developed an enhanced electronic health record template that streamlines communication between CHWs, care providers and health plan managers, making it easier for patients to access care. The three care teams are now able to work from a shared asthma care plan.

 

KCAP’s four CHWs have extensive experience working with individuals to improve health outcomes. Some have backgrounds in social work, medical assistance and medical interpretation, but their strongest experience is their deep familiarity with the communities they serve. CHWs have social and cultural connections and shared life experiences with their clients, which helps ensure that KCAP’s care delivery is culturally relevant. The program currently enrolls clients, both adults and children, to receive up to three home visits from a CHW. Each home visit consists of a home environment assessment, assistance with the identification and management of asthma triggers, and a discussion about medication concerns and adherence. The CHW sets self-management goals and provides practical tools to reach those goals, including a free High-Efficiency Particulate Air (HEPA) vacuum; HEPA air filters for high-risk patients; allergen-control bed covers; food storage containers; green cleaning kits; and an asthma spacer, peak flow meter and medicine boxes.

 

Many clients face pressing stressors that overshadow asthma as a concern, such as poor housing conditions, housing instability and mental health issues. Although CHWs emphasize asthma management, they can coordinate additional services so that these patients can begin to focus on their asthma. CHWs can connect patients with KCAP’s partners and local agencies offering other clinical and social services. The CHWs’ ability to provide culturally competent, empathetic approaches to the many social and environmental causes of asthma have been a cornerstone of KCAP’s success in asthma care for the past 20 years. KCAP’s programming is expanding to include additional partners that can more directly offer clients asthma-related services. These programs include housing weatherization and repairs specific to respiratory disease, tenant advocacy and legal resources, child care consultation, and training for pharmacists on medication adjustment.

 

In addition to working with clients in their homes, KCAP’s current program works with care providers and health plans to change systems and improve delivery of services in the community. KCAP is working with 13 clinics and two health plans to improve clinical care guidelines; equip clinics with spirometry and allergy testing; and optimize electronic health records to improve communication and care coordination between care providers, patients, CHWs and health plans. It also is working with two health plans to improve their Medicaid Managed Care Plans, adding such components as enhanced case management, medication monitoring, and provider notification of emergency room visits or hospital discharge.

 

KCAP’s extensive body of work in environmental asthma management and care coordination is evident in the successful patient outcomes throughout the program’s history. KCAP’s pioneering efforts with the CHW model and care coordination have contributed to decreases in asthma-related hospitalizations and urgent care use, increases in patient and caregiver quality of life, and a greater overall return on investment when compared to standard care. KCAP continues to build the evidence base for the CHW model and patient-centered asthma care, and it serves as an exemplar for asthma care delivery across Washington state and nationwide.

Winnner Photo: 
Winner Photo Caption: 

Over 20 years, King County Asthma Program’s (KCAP) Community Health Worker programs have reached over 4,000 patients in programs to manage environmental asthma triggers and improve care delivery for better health outcomes. Above, CHWs, program staff, and project partners from KCAP’s Guidelines to Practice project.

Award Winner Category: 
Award Year: 

Asthma Regional Council for their New England Asthma Innovation Collaborative

Winner Blurb: 

Health Resources in Action’s Asthma Regional Council (ARC) established the New England Asthma Innovation Collaborative (NEAIC) in 2012 with a Center for Medicare and Medicaid Innovation (the Innovation Center) Health Care Innovation Award. NEAIC’s goal is to improve asthma outcomes, quality of care, and health care costs, especially for Medicaid and State Children’s Health Insurance Program (CHIP)-enrolled children, by advancing asthma home visits and sustainable payment systems across four New England states: Connecticut, Massachusetts, Rhode Island and Vermont. This goal supports the Innovation Center's aim to achieve better care for patients, better health for communities, and lower costs through improvements to the health care system. NEAIC achieves this goal through asthma self-management education; home environmental assessments, including minor-to-moderate environmental intervention supplies to mitigate asthma triggers; and use of nonphysician providers shown to be cost-effective deliverers of this level of care, particularly community health workers (CHWs) and certified asthma educators (AE-Cs).

 

During NEAIC’s 3 years of Innovation Center funding, providers utilized CHWs and AE-Cs to provide evidence-based home visit assessments and interventions. The target population was pediatric patients (ages 2–17) with poorly controlled or uncontrolled asthma symptoms who had a history of using expensive urgent care, with a focus on high-cost Medicaid and CHIP patients. Patients were enrolled in the intervention for an average of 6 to 8 weeks, with followup at 6 and 12 months after the first home visit. Medicaid payers provided patient claims and encounter data to monitor costs and outcomes for their patient populations, and some will consider new reimbursement policies should the interventions demonstrate positive health and cost outcomes.

 

Broadly, NEAIC focuses on four components: (1) workforce development, (2) rapid service delivery expansion, (3) committed Medicaid payers, and (4) a Payer and Provider Learners Community. Each component builds in continuous quality improvement measures through rigorous data collection/analysis, strong partnerships, and commitments from interested payers and policymakers.

 

In support of a well-trained workforce, NEAIC has provided scholarships for individuals to attend an asthma training institute to increase the number of AE-Cs; they also sponsored core training (a 48-hour course) and asthma home visiting training (a 24-hour course) for CHWs. Both asthma educators and CHWs are considered qualified and cost-effective providers. NEAIC also explored payers’ attitudes, knowledge and beliefs about both asthma home visits and CHWs. These conversations led to recommendations for innovative CHW asthma-credentialing programs that payers and provider practices across New England have requested and can benefit from. These combined efforts should contribute to higher-quality and culturally competent care, and NEAIC believes that the demonstrated cost-effective outcomes will help support innovative Medicaid reimbursement.

 

NEAIC experienced rapid service delivery expansion and provided asthma home visits to 1,145 high-risk children with asthma in its four-state service area during its 3 years of Innovation Center funding. Self-reported data and observations during home interventions show improvements to several intermediate factors, including exposure to environmental triggers, which may explain the improved asthma control and reported decreases in the use of health care services. Findings point to improved quality of life for asthma patients and their caregivers, including a nearly 50-percent reduction in the number of days patients missed school because of asthma and a more than 60-percent reduction in their caregivers’ missed work days.

 

Since its inception, NEAIC has engaged Medicaid payers as partners to provide claims data, participate in regional meetings, and consider financing and policy changes should the service model results achieve the Innovation Center’s aims.

 

The Payer and Provider Learners Community exists to rapidly disseminate demonstrated improvements to the quality and cost of asthma care, share viable reimbursement systems developed, successfully incorporate CHWs into the asthma care team, and disseminate best practices across New England. The Learners Community builds on ARC’s existing networks and partnerships across the region to increase awareness about these successful models, with the goal of broader adoption across New England.

 

Through these four components, NEAIC establishes and promotes CHWs as strong health care delivery partners who address environmental conditions as part of the disease management program—with reimbursement by payers—making this an innovative model for broad dissemination and potential replication across the nation.

 

NEAIC’s Partners

 

Clinical Providers

  • Boston Children’s Hospital (Boston, MA)
  • Baystate Children’s Hospital (Springfield, MA)
  • Boston Medical Center (Boston, MA)
  • Children’s Medical Group (Hamden, CT)
  • Middlesex Hospital (Middletown, CT)
  • Rhode Island Hospital/Hasbro Children’s Hospital (Providence, RI)
  • Rutland Regional Medical Center (Rutland, VT)
  • St. Joseph’s Health Clinic (Providence, RI)
  • Thundermist (Woonsocket, RI)

 

Workforce Development Partners

  • Central Massachusetts Area Health Education Center, Outreach Worker Training Institute (Worcester, MA)
  • American Lung Association of the Northeast (Waltham, MA)
  • Boston Public Health Commission, Community Health Education Center (Boston, MA)
  • Massachusetts Association of Community Health Workers (Worcester, MA)

 

Medicaid Payers

  • BMC HealthNet Plan (Boston, MA)
  • Department of Vermont Health Access (VT State Medicaid)
  • Connecticut Department of Social Services (CT State Medicaid)
  • Health New England (Springfield, MA)
  • MassHealth (MA State Medicaid)
  • Neighborhood Health Plan of Massachusetts (Boston, MA)
  • Neighborhood Health Plan of Rhode Island (Providence, RI)

 

Winnner Photo: 
Winner Photo Caption: 

Marie Gilmond (Rutland Regional Medical Center, VT), Susan Sommer (Boston Children’s Hospital, MA), Veronica Mansfield (Middlesex Hospital, CT), Stacey Chacker (Health Resources in Action), Megan Sandel (Boston Medical Center, MA), Annie Rushman (Health Resources in Action), Elizabeth McQuaid (Hasbro Children’s Hospital, RI), June Tourangeau (St. Joseph Health Center, RI), Michael Corjulo (Children’s Medical Group, CT). Missing from this picture is Matthew Sadof (Baystate Medical Center, MA), Donna Needham (Thundermist Health Center, RI) and Heather Nelson (Health Resources in Action)

Award Winner Category: 
Award Year: 

The Green & Healthy Homes Initiative

Winner Blurb: 

The Green & Healthy Homes Initiative (GHHI) serves low-income families living in Baltimore City, Maryland, using a transformative asthma management model that combines in-home family asthma education; a comprehensive health, safety and home energy audit; and root cause remediation.

 

Residents of Baltimore City, Maryland, face a higher than average rate of asthma prevalence, hospitalizations, emergency visits and deaths compared with residents of other Maryland regions and the nation as a whole. Approximately 18.6 percent of Baltimore City children have asthma, compared with the national average of only 5 to 8 percent. Furthermore, African Americans living in Baltimore are disproportionately affected. African Americans with asthma visit the emergency room 6.5 times more often than Caucasians. The asthma hospitalization rate for children in Baltimore City is twice the rate of Maryland as a whole, and African Americans in Baltimore experience an asthma mortality rate that is     3 times higher than that of Caucasians.

 

Working as a coalition of 35 federal, state, local, nonprofit, university and philanthropic partners, GHHI provides health-based housing intervention services to families with asthmatic children ages 2–14 who live in neighborhoods with the highest rates of asthma in the state. Homes in these very low-income communities usually are in deteriorating condition, with such environmental health hazards as high levels of dust, pest antigens, mold and very poor indoor air quality. Following the recommendations of an Environmental Assessment Technician’s report, GHHI deploys professional hazard reduction crews to remediate these home-based environmental hazards to reduce and eliminate avoidable asthmatic episodes.

 

GHHI began in Baltimore, Maryland, as the Coalition to End Childhood Lead Poisoning. Although originally focused on reducing lead hazards, the organization’s community-based workers perceived that other home-based environmental health hazards—especially asthma triggers—also demanded attention to support children’s health. In 2000, with seed money from the Annie E. Casey Foundation, the Coalition established one of the first Healthy Homes programs in the nation. In 2013, the Coalition changed its name to GHHI to reflect its broadened scope of services and mission impact, with Baltimore as its flagship site.

 

Since 2000, GHHI Baltimore has conducted housing interventions in 1,118 homes of patients diagnosed with asthma in Baltimore City. By remediating home-based environmental asthma triggers, GHHI has effectively reduced the incidence of asthma among those patients and stopped avoidable visits to the Emergency Department (ED) and hospital. GHHI’s highly successful approach served as the model for Baltimore City’s Office of Green, Healthy and Sustainable Housing. Unlike other Healthy Homes programs, GHHI integrates “green” weatherization and energy efficiency work with traditional healthy homes services, such as integrated pest management and mold removal, to achieve maximum health benefits for the target population. Moreover, GHHI Baltimore builds the community’s human capital. GHHI does this by deploying its own team of contractors to conduct multi-component home interventions and by hiring residents of at-risk Baltimore communities who receive training and accreditation to conduct interventions.

 

The Maryland Department of Health and Mental Hygiene’s (MDHMH) most recent data showed that, in 2009, 5,514 children in Baltimore City went to the ED for asthma, of whom 792 children who were hospitalized. Data also indicate that 52 percent of children in Baltimore who are hospitalized with asthma are residents of GHHI Baltimore’s target communities. If 52 percent of the city’s 5,514 children with asthma ED visits reside in GHHI’s target communities, GHHI Baltimore reaches approximately 4–7 percent of all children with persistent to severe asthma in those communities. To serve these children, GHHI has an intake stream from established referral sources and long-term partners, including managed care organizations (MCOs) and asthma clinics. GHHI annually serves 100–200 children diagnosed with asthma.  

 

GHHI’s integrated, community-based approach involves all of the necessary partners to provide comprehensive care.  With MDHMH funding, GHHI provides training to clinicians and staff of local community clinics and participates in Grand Rounds Trainings for physicians, pediatricians, nurses and other health care providers. GHHI reaches approximately 100 health care providers annually through the Initiative’s instruction on integrating home-based and environmental-focused intervention with comprehensive clinical care. When patients enter the program, an environmental assessment and education team meets with the family to review their home conditions. A GHHI Environmental Asthma Educator serves as the primary point of contact among the family and provider/nurse care manager/case management. The Environmental Asthma Educators staff review the patient’s Asthma Action Plan and medication management. The home asthma educators reinforce the information provided by the clinician and ensure that any behavior that may impact asthma, such as smoking, is addressed.

 

Besides serving clients directly, in the last 7 years, GHHI has conducted 1,743 outreach presentations and events, including 168 school presentations, 154 daycare center events, 742 community center events and 70 MCO presentations, providing more than 121,912 Baltimore City residents with information about healthy homes and asthma prevention.  

Winnner Photo: 
Winner Photo Caption: 

Green & Healthy Homes Initiative sites from across the country met in Washington, DC last fall to present a congressional briefing on the health, social and economic benefits of green and healthy housing.

Award Winner Category: 
Award Year: 

Multnomah County Health Department

Winner Blurb: 

Multnomah County Health Department partners with organizations at the national, state and local levels to deliver a multi-component healthy homes program across Portland and Multnomah County, Oregon.

 

The Healthy Homes Program developed as a result of a community assessment which was guided by the efforts of a community-based environmental health coalition. The coalition was comprised of a network of 45 community-based organizations, local agencies and public officials and was instrumental in developing and implementing a community-based environmental health assessment to identify community environmental health concerns. The goals were to identify environmental health issues, prioritize issues, develop action plans and evaluate the progress to address selected issues. 

 

The assessment data and results became the impetus for developing the Healthy Homes Asthma program and focusing on improving indoor air quality and reducing asthma triggers in the homes of low income families with children with asthma. The Multnomah County Environmental Health Services (MCEHS) sponsored the Healthy Homes Coalition, which emerged from the Summit with a goal to address environmental factors that affect asthma and other health conditions by prioritizing substandard housing and housing codes.

 

The work of the coalition resulted in the successful submission of a grant to the Department of Housing and Urban Development (HUD) Healthy Homes program in 2005. With HUD funding, MCEHS began delivering in-home nursing case management, environmental assessments, behavioral interventions and supplies to reduce asthma triggers for low-income families of children with asthma. In addition to direct care services, the program also focused on policy development, housing code enforcement, integration with clinical providers, and connections to remediation and community support resources.

 

MCEHS initially developed the Healthy Homes Program for low-income children with asthma who received primary care at county health department clinics. In 2009, MCEHS developed an Asthma Inspection and Referral (AIR) program, a one-time home inspection program for any child with asthma, regardless of income. AIR augmented the more in-depth Healthy Homes program, which targeted low income and less controlled children with asthma. Over time, the Healthy Homes Program broadened its services, developing the Community Asthma Inspection and Referral (CAIR) program funded by a HUD Demonstration Grant, to deliver home assessments to an even broader group of children with asthma and other environmentally related health conditions. Referrals to the Multnomah County Asthma programs now come from clinic providers and other community organizations throughout Multnomah County. Through a web based referral system the programs were able to accept referrals from community medical providers, community based organizations and other partners through-out the county. MCEHS and its growing group of partners continued to expand the services and reach of the Healthy Homes to include Healthy Homes, AIR, and CAIR. Working in collaboration with other community partners such as the City of Portland, they seek to address asthma at the individual, family, organizational, community and public policy levels to improve outcomes for all children in the county.

 

MCEHS' Healthy Homes program is available to low-income families and prioritizes children with uncontrolled asthma who have had recent ER visits, or who are prescribed inhaled corticosteroids. Healthy Homes positions a Community Health Nurse (CHN) as the child's case manager and a Community Health Worker (CHW) to help manage the home environment. Together, they conduct approximately seven home visits and provide ongoing telephone support. CHNs receive referrals, review cases and consult with providers. During home visits, CHNs focus on assessing asthma severity and control, reviewing medication, and developing individualized asthma care plans. CHWs work with families on environmental assessments and interventions. Both CHWs and CHNs link families to support resources; CHNs link to medical services and consult with the medical team and pharmacy, while CHWs connect families to remediation and other services.

 

Over approximately six months, Healthy Homes program CHWs provide customized assistance in implementing the Family Action Plan. Assistance consists of in-home and telephone support, education ,behavioral interventions, skill-building demonstrations and providing supplies, such as green cleaning kits, vacuum cleaners with HEPA filters, allergen-free bedding encasements, door mats, bed frames and linens. In addition, families may be given basic maintenance items such as batteries for smoke detectors, furnace filters or new smoke detectors. Client assistance items average $336 per family.

 

With the expansion of the initiative to add CAIR, providers and social service agencies began to use a Web-based system for referrals, charting, and reporting. In AIR an Environmental Health Specialist (EHS), performs a single environmental assessment. If appropriate, he might refer clients directly into Healthy Homes or CAIR. CAIR program staff included two CHWs who served as case managers. They conducted environmental assessments, basic interventions, addressed behaviors and make referrals. Physical and structural remediation concerns were referred to the EHS who was able to leverage services for home repair. Uncontrolled health issues were referred to the CAIR CHN.

 

The Healthy Homes program has collected outcomes data since 2005, and the CAIR program has collected data since its inception in 2010. Both Healthy Homes and CAIR programs tracked environmental assessment scores, asthma control test (ACT) scores and ER visits.

 

The Healthy Homes program has demonstrated a 2.5 times reduction in the use of ER and significant reduction in hospitalizations for children with asthma who have completed the program. In addition, the Healthy Homes intervention is associated with a statistically significant reduction in the number of environmental observations of asthma triggers in both Healthy Homes and CAIR. Finally, 75 percent of Healthy Homes' clients showed improved ACT scores over a six month period. Based on a 2008 evaluation conducted in partnership with Care Oregon, the managed care plan that served 99 percent of Healthy Homes' participants at the time of the evaluation, the program resulted in almost $350,000 in savings from avoided health care utilization (i.e., avoided hospitalizations and ED visits).

 

To sustain the program, MCEHS advocated for direct reimbursement from the State of Oregon. In 2010 MCEHS negotiated with Oregon Department of Medical Assistance Programs and Center for Medicaid Services, CMS to develop Healthy Homes targeted case management, allowing for Medicaid reimbursement. In addition, the Healthy Homes Coalition continues to seek to embed environmental solutions for asthma in the housing code, improve substandard housing and advocate for tenants.

Winnner Photo: 
Award Year: 
Award Winner Category: 

North East Independent School District (Asthma Awareness Education Program)

Winner Blurb: 

The North East Independent School District (NEISD) is a large urban district that serves 67,000 students, including more than 8,000 with asthma. In 2006, NEISD hired a registered respiratory therapist/certified asthma educator (RRT/AE-C) to launch an asthma management program to improve students’ asthma control and attendance in order to positively contribute to the district’s academic performance.

 

NEISD’s investment in the Asthma Awareness Education Program (AAEP) reflects its leadership’s recognition that asthma control is fundamental to student achievement. The AAEP’s evaluation data have demonstrated that comprehensive school-based asthma management programs can improve disease management, reduce emergency health care utilization, and increase school attendance, thus impacting academic performance and generating a return on investment. In Texas, as in a handful of other states, average daily attendance rates are at the foundation of the state’s formula for distributing school revenue. An effective school-based asthma control program like NEISD’s can quickly increase attendance and thereby pay for itself.

 

The AAEP provides education, disease management tools, and other support to help school nurses identify and monitor students with asthma and to improve communication with clinical staff. NEISD also provides case management services for children with hard-to-control asthma, including RRT/AE-C-led home visits, personalized counseling and coordination with asthma specialist physicians. The Asthma Blow Out (ABO) is the AAEP’s community engagement component, which is delivered in areas with the largest disparities in asthma outcomes. The ABO brings RRT/AE-Cs and physician partners to local schools where they explain disease management strategies and medication use, dispense flu vaccines and provide age-appropriate asthma education to students, parents and caregivers. To decrease healthcare barriers, where indicated, NEISD provides bus transportation to and from the schools, free meals, English-Spanish translation services, and offers academic incentives for students to attend the ABO events.

 

The AAEP addresses environmental asthma triggers in schools through training for custodial staff, principals and teachers, as well as through monthly meetings with facilities staff. The district also incorporates an asthma management component in the high school’s Healthy Lifestyles course; has implemented an air quality health alert policy to ensure the campus community knows when unhealthy outdoor air conditions occur; and conducts regular monitoring of asthma symptoms and possible environmental exposures in schools. The AAEP also promotes environmental asthma management at home.

 

In the six and a half years since the program’s launch, the AAEP has reduced asthma symptoms in school as measured by declines in rescue/reliever medication use. For example, inhaler use declined by 50 percent during the first six weeks of school from the first year to the next. Emergency medical service transports during the school day also decreased from 80 transports per year to 24 transports per year. The AAEP has delivered asthma education to every district campus by reaching every physical education teacher, nurse and campus administrator. ABO survey results also demonstrate improved student and parent understanding of appropriate asthma management strategies – 95 percent of parent attendees surveyed said they would recommend the ABO program to a friend. Additionally, the district has seen yearly attendance averages increase from 95.3 percent to 96.1 percent since the AAEP’s inception, including significant increases during flu season. NEISD has achieved state recognition for its academic performance four years in a row. There is widespread agreement that the AAEP-led environmental improvements and involvement in student health contributed to improved student performance and the district’s academic accomplishments.

Winnner Photo: 
Winner Photo Caption: 

[Pictured front row] l-r: Diane Rhodes and Kathy Hardin [Pictured back row] l-r: Girish Nair, Larry Fowler, Nick Kellar In cooperation with campus nurses, custodial staff, PE teachers, administrators and district facility maintenance staff.

Award Winner Category: 
Award Year: 

Michigan Department of Community Health Asthma Prevention and Control Program

Winner Blurb: 

In the mid-90s, the Michigan Department of Community Health (MDCH) recognized asthma as a growing health problem, especially among low-income children and populations with economic, race and access disparities. As MDCH geared up to increase asthma awareness in these disproportionately affected communities, it quickly determined that a coordinated effort would ultimately have the greatest impact on health outcomes.

 

Therefore, in 2000, MDCH brought together more than 125 asthma experts to develop the first statewide plan to address asthma in communities bearing the highest burden. This successful collaboration lead to the creation of the Asthma Prevention and Control Program (APCP). 

 

The APCP, which provides expertise and long-term guidance for asthma quality improvement activities, has aided in the development and impact of many successful community-based asthma management programs across the state, such as Managing Asthma Through Case-management in Homes (MATCH). This program utilizes a combination of home, school and work visits; asthma action plans; and Medicaid reimbursement to provide long-term interventions and care for individuals with asthma. MATCH participants reported significantly fewer emergency room visits and hospitalizations, and had significantly shorter lengths of stay, if hospitalized due to asthma.

 

Recognizing the success of the program, APCP helped to replicate this model in other communities, and as a result, has more than doubled the number of people served by MATCH. Surveillance data and input from strategic partners have been key components to this success and are used to continuously measure both the state’s and community’s needs and to ensure that any changes in asthma burden result in adjusted programming.

 

Between 2000 and 2007, APCP’s efforts have contributed to a 24 percent reduction in the asthma mortality rate in Michigan, preventing an estimated 182 deaths. Similarly, pediatric asthma hospitalization rates in the state decreased by 28 percent between 2000 and 2009. In addition, children enrolled in Michigan Medicaid programs exhibited a 41 percent decrease in asthma hospitalizations between 2005 and 2009. 

Winnner Photo: 
Winner Photo Caption: 

[Front row] l-r: Evelyn Gladney, Erika Garcia, Tisa Vorce, John Dowling [Back row] l-r: Bob Wahl, Judi Lyles, Sarah Lyon-Callo, Bill Baugh

Award Winner Category: 
Award Year: 

Easy Breathing at Connecticut Children's Medical Center

Winner Blurb: 

In 1998, the city of Hartford, Connecticut had a growing population of low-income minority citizens with asthma. Only one-third of children with persistent asthma in this community were being treated with appropriate anti-inflammatory medication, and most of these children lived in old housing where pest infestation and overcrowding were common problems.

 

The community needed a cost effective asthma management program to assist busy primary care clinicians in diagnosing asthma and effectively treating patients. The result was the creation of the Easy Breathing© program.

 

Easy Breathing© — originally housed within the Connecticut Children’s Medical Center — focuses on five elements of care: diagnosing asthma, determining asthma severity, prescribing therapy appropriate for the asthma severity, developing a written Asthma Treatment Plan that is understood by the family, and assessing asthma control.

 

The program then utilizes a database to track its outcomes, including environmental exposures, interventions and feedback for clinicians. The database is also used for research and reporting purposes, and it provides clinicians with information regarding the demographics of their patient population, environmental exposures and asthma severities for all children enrolled in the program.  

 

An essential element of the program is the Easy Breathing© Survey, which is administered in the physician’s office when the patient comes for an office visit. The survey helps parents identify environmental exposures in the home that are potentially problematic for a child with asthma. The results of the survey are then immediately discussed with the patient and are used as a starting point for education regarding avoidance and elimination of harmful environmental conditions, such as smoking in the home.   

 

Today more than 106,000 children across the state have been enrolled in the Easy Breathing© program — more than 28,000 of which have asthma. This success is due in large part to extensive community partnerships between clinicians, parents, hospitals, clinics, schools, foundations, lung associations, housing authorities and pharmaceutical industry representatives that have been a cornerstone of the program from its inception.

 

Easy Breathing© has been tremendously successful and has lead to significant increases in the use of written treatment plans, decreases in hospitalization rates and emergency department visits for asthma, and increased usage of inhaled corticosteroids. The program is now being implemented throughout Connecticut and in nine other states.

Winnner Photo: 
Winner Photo Caption: 

Michelle M. Cloutier, MD, the Program Director of Easy Breathing at Connecticut Children’s Medical Center

Award Winner Category: 
Award Year: 

New York State Department of Health, Center for Environmental Health, Healthy Neighborhoods Program

Winner Blurb: 

In the early 1980s, the New York State Department of Health, Center for Environmental Health recognized that housing hazards were often complex and were best addressed by a neighborhood-level approach. As a result, the Center developed the Healthy Neighborhoods Program in 1985 — a statewide program aimed at improving housing conditions in high-risk communities through a holistic, healthy homes approach.

 

This program relies on an extensive network of grant-funded, local health department partners and emphasizes home environmental management as an enhancement to case management and clinical care. Local health departments initially identify target areas in the community for intervention and develop work plans to meet the specific needs of that area. These health departments are also encouraged to leverage local resources and infrastructure to ensure that the services delivered are meaningful and effective. 

 

During home visits, field staff members assess a wide variety of healthy homes issues, including tobacco control, fire safety, lead poisoning prevention, indoor air quality, asthma control, injury prevention and more. Following the assessment, residents are provided with products, referrals and education to help remediate any potential hazards identified during the assessment. A quarter of homes receive a three-to-six month follow-up visit to reassess conditions. Any new or ongoing problems identified during the revisit are addressed.

 

This program has had incredible success for residents with asthma, with marked improvements in environmental triggers, including a 14% reduction in environmental tobacco smoke exposure and improved pest control in at least 44% of homes with pest problems. There have also been significant improvements in participants’ knowledge about asthma triggers and significant decreases in the number of days with worsening asthma and in the number of work or school days missed due to asthma.

Winnner Photo: 
Winner Photo Caption: 

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 Amanda Reddy and Theresa McCabe of the New York State Department of Health, Center for Environmental Health, Healthy Neighborhoods Program

Award Winner Category: 
Award Year: 

Asthma Network of West Michigan (ANWM)

Winner Blurb: 

The Asthma Network of West Michigan (ANWM) is a community coalition that provides comprehensive home-based case management to 82,933 children and adults with asthma in West Michigan. ANWM has demonstrated impressive results including improved health outcomes and cost savings. This success has led to a partnership with Priority Health (a winner of the 2007 National Environmental Leadership Award in Asthma Management) who agreed to reimburse ANWM for its home visit program. This partnership with Priority Health is the nation’s first agreement between a grassroots coalition and a managed care plan. ANWM now has contracts with five local health plans and its asthma management program provides asthma education, coordination with health care providers, development of asthma action plans, home environmental assessments, and social service support. ANWM’s comprehensive care costs $2,500 per person annually and has led to a 64 percent decrease in hospitalizations and a 60 percent decrease in ER visits. These improved health outcomes resulted in approximately $800 in net health care cost savings per child per year.

Winnner Photo: 
Winner Photo Caption: 

Elizabeth Cotsworth, then Director, Office of Radiation and Indoor Air, U.S. EPA, and Beth Craig, then Deputy Assistant Administrator, Office of Air and Radiation, EPA, and Chris Draft, then NFL player, present Award to (from left to right) Karen Meyerson, Mark Huizenga and Lil De Laat of the Asthma Network of West Michigan (ANWM)

Award Winner Category: 
Award Year: 

Pages

Views expressed on AsthmaCommunityNetwork.org do not necessarily reflect EPA or MCAN policy or guidance. Read full disclaimer »