Community coalitions successfully improve asthma health outcomes.
New research finds that community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.
MA Community Events
Rhona (from Region 1 EPA) held a wonderful community event in Trotter Park, Dorchester, MA. I just wanted to let everyone know how impressed I was with a family being managed by Boston Medical Center.
asthma
hello all,
i am doing a research on asthma i would appreciate if you could all answe few of my question....
it would be a great help......
what kind of asthma related problem do you all search for in health portals?(cause, symptoms etc)
Social media sites
Is anyone aware of any social media sites related to asthma management?
Thanks, Mary
Massachusetts' budget mandates payment for comprehensive asthma care
It seems many of us are struggling with the same challenges: How do we provide evidence-based interventions and treatments that can successfully manage asthma without sustainable financing? How do we convince policymakers and payers to invest in models and new approaches to asthma care that will not only improve health outcomes, but also are cost-effective?
Woodhull Medical and Mental Health Center Snapshot
Community Program
Location
Brooklyn, NY
Type
Health care system (part of New York City's public hospital system)
Service Area
North Brooklyn
Population Served
_TRUNCATED_
Key Players
American Lung Association of NY, EPA and Rutgers University, Williamsburg Greenpoint Organization United for Trash Reduction and Garbage Equity, Brooklyn Public School District 14, Bushwick Brownfield Opportunity Area, Brooklyn Clear the Air Coalition, Woodhull North Brooklyn Health Network Quit Smoking Program, King’s County Hospital, New York State Department of Health, New York City Department of Health and Mental Hygiene, Pest at Rest, Visiting Nurse Regional Health Care System
Results
A comparison of health care utilization in the six months prior to clinic participation against the six month period following clinic participation for 322 current pediatric patients showed a 67% reduction in hospitalizations and a 58% reduction in ED visits.
The Woodhull North Brooklyn Health Network (Woodhull) is the primary safety net hospital for North Brooklyn. Woodhull began its comprehensive asthma management program in 1998 to respond to high asthma rates in the community. The program's goal is to ensure that everyone seen at any of the 15 Network facilities receives the same high standard of asthma care resulting in improved self-management and improved health outcomes.
Building The System
Let the Data Guide Program Planning, Design and Implementation
Woodhull developed its asthma program to address the high pediatric asthma rates and poor outcomes in North Brooklyn. Research showed that children in the area suffered disproportionately from exposure to asthma triggers. Also, the numbers of pediatric patients with recurrent emergency department (ED) visits and hospitalizations for asthma indicated a lack of adequate clinical care. Woodhull leaders selected an evidence-based approach--the Chronic Care Model--to tackle pediatric asthma. Their approach included improving the quality of care and strengthening connections between and among care providers and the at-risk community the program is designed to reach. Woodhull aimed to decrease ED visits and hospitalizations by 50% within five years. To achieve these goals, the program delivers asthma care in a clinic that serves all regardless of their ability to pay; trains providers to improve the quality of care across the network; collaborates with local schools to identify and educate children with asthma; delivers home visits and case management for the highest risk patients; provides enhanced asthma care in the ED; and works through wide-ranging community collaborations to provide social and environmental support to families in need.
Woodhull developed their comprehensive asthma clinic as part of it parent organization, the New York City Health and Hospitals Corporation, Chronic Care initiative. The asthma clinic helps to ensure that all children with an asthma diagnosis in the Woodhull Network receive treatment in accordance with the National Guidelines for the Diagnosis and Management of Asthma (EPR-3). The Woodhull asthma program also began training attending, community and ED doctors, residents and nurses on the EPR-3 and implemented a number of innovations to reinforce the delivery of EPR-3-based care. For example, Woodhull modified their electronic health record to make it impossible to close an asthma encounter without providing a medication prescription based on severity classification. Woodhull also implemented a program to educate patients before clinical visits to ensure they are prepared to ask questions that will elicit high quality and personalized care from providers.
Key Driver
STRONG COMMUNITY TIES--MAKE IT EASY TO ACCEPT SERVICES
Woodhull makes high-quality asthma care convenient for children with poorly controlled asthma. Early in the program's development, Woodhull renovated the ED with a state-of-the-art asthma treatment room and began training ED doctors on EPR-3-based asthma care. It also eliminated the traditionally long wait times for patients to begin emergency medication by adding social workers on site to help with paperwork while patients receive nebulizer treatments. Because many underserved pediatric asthma patients end up at the ED, these enhancements ensure they receive the best care possible even under suboptimal circumstances. Also, asthma program staff contact patients seen in the ED within a few days to schedule a follow-up appointment at the clinic.
Getting Results - Evaluating The System
Evaluate Program Implementation and Program Impact
Woodhull assesses its asthma program by surveying providers who receive education through the Physician and Nursing Asthma Care Education (PACE) program. PACE participants report they are now more likely to prescribe inhaled anti-inflammatory therapy, give patients written treatment plans, review instructions for new medications with patients and address patients' fears about using new medications. Woodhull also assesses whether the providers' asthma education is actually affecting the quality of care. This is done by tracking registry data on the percent of the population who have asthma diagnoses that have been classified for severity; and have received appropriate medications, asthma action plans (AAPs) and tobacco screenings. The registry also provides outcomes data on hospitalizations and ED visits. Woodhull's results are impressive. Comparing ED visits and hospitalizations for 322 pediatric patients in the six months prior to clinic participation to the rates in the six months after, showed a 67% reduction in hospitalizations and a 58% reduction in ED visits.
Key Driver
INTEGRATED HEALTH CARE SERVICES--PROMOTE ROBUST PATIENT/PROVIDER INTERACTION
Patient People Reaching Empowerment Program (PREP) for Asthma cards present the EPR-3 for asthma care in lay terms to educate consumers about what constitutes a comprehensive, quality visit. This information empowers patients to take control of their own asthma care and form a relationship with their providers. For example, the pediatric PREP card, includes a question about medication availability at school, AAPs and peak flow meters to prompt families to discuss these aspects of care with providers and prompt providers to take action if the child is missing any of these elements of care.
Sustaining The System
Promote Institutional Change for Sustainability
As clinical and provider training programs took root within the Woodhull system, the asthma program began partnering with health care organizations and providers, community and faith-based organizations and community leaders to create the venues needed to deliver a single high standard of asthma care to the entire community. Woodhull received funding from the New York State Department of Health (NYDOH) Office of Minority Health to spearhead a coalition focused on racial disparities in asthma care. This led to the creation of the North Brooklyn Asthma Action Alliance (NBAAA), a community coalition to champion policy-level change in asthma management in schools; increased awareness of patient rights; and expansion of the PACE program to reach providers across the community. Because of the commitment of its members to health, environmental and social justice issues, the NBAAA has continued to meet on a voluntary basis even during periods when funding has lapsed.
Woodhull has carefully applied grant funding to promote institutional change, thereby minimizing the need for future grant funding to sustain improvements. For example, in the most recent five-year period, NYDOH funded Woodhull to expand its coalition to reduce the asthma burden statewide. This approach resulted in partnerships with local schools to institute policy-level changes to ensure "asthma friendly" school environments. It also led to the development of new policies regarding animals in the classrooms, the use of carpeting, enforcement of the bus idling law and the use of green cleaning products. Once established as policy, environmental management of asthma became part of the institutional culture in the school system and, therefore, the intervention continues even after the funding period. Similarly, a Centers for Disease Control and Prevention grant that funded the development of the computerized asthma registry to track patient care helped to prove the concept and value of a computerized disease registry. Now the registry system is part of the infrastructure of the program and the hospital has maintained it beyond the pilot funding period.
Key Driver
Woodhull developed the first asthma friendly school program in New York City when the hospital worked with local school principals and parent coordinators to develop a school environmental assessment checklist. The program later integrated EPA's Indoor Air Quality Tools For Schools guidance and, in partnership with EPA and Rutgers University, now delivers comprehensive education on environmental asthma triggers in schools and how to manage them. In addition, Woodhull designates one of their certified asthma educators as a schools liaison to promote coordination of care for children at school. The liaison rotates pediatric residents to the 15 public schools in the district to provide asthma education to parents and school staff and screen children for asthma. Woodhull also maintains an asthma-friendly environment in the hospital-run day care center and offers workshops to community day care centers on how to manage asthma and the triggers of asthma.
Program Profile Top Link
2010 U.S. EPA National Environmental Leadership Award in Asthma Management Winner
Program Profile Bottom Link
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Washington Heights/Inwood Network (WIN) for Asthma, New York Presbyterian Hospital Snapshot
Community Program
Location
New York, NY
Type
Non-profit Community Partnership
Service Area
Washington Heights/Inwood, New York City
Population Served
_TRUNCATED_
Key Players
New York Presbyterian Hospital Ambulatory Care Network, Columbia University College of Physicians and Surgeons, Morgan Stanley Children’s Hospital of New York, Healthy Schools Healthy Families, Visiting Nurse Service of New York, Columbia University Mailman School of Public Health
Results
After 12 months in the program, according to survey data, caregiver confidence in controlling their child’s asthma increased by 40%, ED and hospitalization rates decreased by more than 50% and child school absenteeism decreased by 30%. During this same period, WIN trained and supported more than 300 physicians.
The WIN for Asthma program reduces the burden of asthma in a low-income, culturally diverse, urban community, where pediatric asthma rates are high--childhood asthma rates are four times the national average--access to care is fragmented and a range of obstacles to effective asthma control makes pediatric asthma a major public health problem. In 2005, Merck Childhood Asthma Network - MCAN - gave researchers a four-year grant to address pediatric asthma disparities through WIN, a hospital-community partnership to strengthen the community's existing network of care in order to improve outcomes for children with poorly controlled asthma. WIN's goal is to reduce severe asthma exacerbations, to decrease asthma-related emergency department (ED) visits, hospitalizations and school absenteeism.
Building The System
Conduct Needs-Based Planning--Seek Input from the Community
Community ownership and integration has been built into WIN's program design from the start. When they received the MCAN grant, the researchers who initiated WIN convened a network of community stakeholders committed to filling gaps in the local system of asthma care. The research team and representatives from four community-based organizations--Alianza Dominicana, Inc., Northern Manhattan Improvement Corporation, Fort George Community Enrichment Center and Community League of the Heights--joined together to design WIN. They applied the principles of community-based participatory research and spent the first nine months setting program strategy, recruiting and training staff from the community, developing asthma care guidelines and protocols, creating evaluation tools and forming the WIN Leadership Task Force. The Task Force, which includes stakeholders from the community, Columbia University and the hospital, oversees and supports WIN programming.
Ensure Mission-Program Alignment
To ensure it stays focused on asthma disparities, WIN works hard to find and treat at-risk children by conducting screening for uncontrolled asthma in daycare facilities, schools, clinics and other community organizations. In addition, all children admitted to the Morgan Stanley Children's Hospital of New York with a diagnosis of asthma are automatically referred to WIN. Through its broad network of collaborators, WIN is able to assess a large pediatric population. Families of children who meet the risk criteria are offered WIN's intensive year-long care coordination service.
WIN's target population is multi-lingual, culturally diverse, has low levels of health literacy and high levels of poverty and faces multiple obstacles that often prevent effective asthma care. To make it easy for families to support effective asthma care for their children, WIN's care model uses bilingual community health workers (CHWs) located in organizations across the community. The CHWs serve as the single point of contact for families to facilitate culturally-appropriate and comprehensive asthma education, home environmental assessments, support for setting individualized asthma control goals, referrals for clinical and social services and ongoing support. The CHWs, who are linked to the hospital and the community, facilitate communication with clinicians, provide broad-spectrum support to families and strengthen ties between the health care system and the community.
Key Driver
STRONG COMMUNITY TIES--MAKE IT EASY TO ACCEPT SERVICES
Many caregivers in the community face serious obstacles that prevent them from appropriately caring for their child's asthma. Through WIN, all families receive referrals for support services, including immigration, domestic violence, employment, housing, mental health, smoking cessation, tenants rights, housing assistance and others. A secondary benefit is that the referrals further link families to the community by connecting them to local resources. WIN leaders believe that a good deal of the program's success is attributable to helping families address life's obstacles as well as their child's asthma.
Getting Results - Evaluating The System
Evaluate Program Implementation and Program Impact
WIN seeks to reduce severe pediatric asthma exacerbations and related healthcare utilization through intensive care management and improvements in the quality of clinical asthma care. WIN evaluates its efforts and their impact through process measures to assess implementation of the care management program, including: the percent of families who accept home visits; the percent of those who take steps to make their homes asthma-friendly; and the number of community providers who receive education and engage in WIN's quality improvement (QI) initiatives. WIN also assesses the program's outcomes through a survey of caregivers with children enrolled in the care management program.
WIN conducts caregiver interviews during enrollment in the care management program and again at 6 and 12 months. Descriptive statistics assess the impact of the intervention on caregiver self-efficacy and key asthma morbidity indicators. Over a three-year period, CHWs enrolled 360 families. After 12 months in the program, caregiver confidence in their ability to control their child's asthma increased by 40%, ED and hospitalization visit rates decreased by more than 50% and child school absenteeism decreased by 30%. In addition, WIN engaged 306 providers based in Washington Heights/Inwood and Harlem in an asthma care education program and 60 local pediatric providers in an asthma care QI initiative. The education program reached the vast majority of community pediatric providers and enhanced the delivery of National Guidelines for the Diagnosis and Management of Asthma (EPR-3) throughout the community.
Key Driver
INTEGRATED HEALTH CARE SERVICES--EDUCATE AND SUPPORT CLINICAL CARE TEAMS
To strengthen the local network of care, a provider outreach team engages and supports providers in Physician Asthma Care Education (PACE) and QI initiatives. PACE reaches the majority of pediatric providers in WIN's community with trainings on the clinical aspects of asthma, medication management and introduction and reinforcement of the EPR-3 and communication skills to address asthma during patient encounters. PACE also covers the importance of asthma action plans and how to educate parents on their use. In partnership with the National Initiative for Children's Healthcare Quality, WIN developed a QI protocol for post-PACE provider support. Providers receive one-on-one training in their practice on QI projects for asthma. A WIN provider liaison helps providers establish projects and track their improvements over time. This led to widespread implementation of the EPR-3 through projects initiated by the providers themselves.
Sustaining The System
Be Visible: Funders Support What They Know
At the beginning of the 2005-2009 MCAN grant, WIN's founders explored where within the NewYork Presbyterian Hospital system to house the program. Early on, they recognized that positioning WIN under the Director of Community Health Outreach and Marketing in the Ambulatory Care Network would allow the program to develop within an established framework for hospital-community programming and provide a mechanism for partnering with ambulatory clinics that serve many local children with asthma. Under these auspices, WIN established itself as the hospital's "asthma program" and collaborated with multiple hospital divisions, increasing the program's visibility.
During the last year of MCAN funding, WIN convened a multi-disciplinary group to develop a Business Plan for WIN to document the program's return on investment and cost savings associated with reduced healthcare utilization. This effort contributed to WIN's sustainability by spotlighting the program's health outcomes. This resulted in the unintended benefit of recruiting program champions from the high-level Business Plan team, including Community Health and Finance Departments and from the Office of Strategy. The hospital recently decided to contribute to the financial support of WIN.
Program Profile Top Link
2010 U.S. EPA National Environmental Leadership Award in Asthma Management Winner
Program Profile Bottom Link
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