Children’s Hospital Boston developed the Community Asthma Initiative (CAI) in 2005 in response to alarmingly high rates of asthma among children living in Boston’s urban neighborhoods, especially underserved children and families. CAI is a patient-centered program that provides bilingual (Spanish) in-home family asthma education, environmental assessments and remediation; Integrated Pest Management; and coordination with primary care providers, in conjunction with community education, outreach and advocacy. Care is provided and coordinated through a culturally appropriate case management model that identifies barriers to good asthma control and includes home visits conducted by nurses and/or community health workers, depending on the family’s needs. To ensure it provides the services and information the community needs most, CAI convenes a Family Advisory Board. In response to the Family Advisory Board’s vision, CAI delivered an Asthma Community Forum, with over 100 attendees discussing asthma-related issues, including environmental management in homes and schools. CAI also offers educational programs and activities for community-based organizations, schools and provider groups. For example, CAI, along with the Boston Public Health Commission (BPHC), hosts the Boston Asthma Swim Program, which provides children with asthma the opportunity to engage in physical activities while learning about asthma control. To improve insurance coverage for case management and home visits—and to increase access to affordable medications and reimbursements—CAI works closely with the Office of Government Relations at Children’s Hospital Boston, BPHC and community partners, providing support for policy and system changes. The Initiative has achieved impressive results. For CAI patients, asthma-related emergency department visits have dropped by 65 percent and hospitalizations have decreased by 81 percent. Further, CAI calculated a 146 percent return on investment (ROI) to society due to lower hospital costs. Enrolled families have also reported a reduction in the limitation of physical activity (37 percent), asthma- related school absences (39 percent), and asthma-related work absences (49 percent).
Founded in the late 1980s, Neighborhood Health Plan (NHP) was one of the nation’s first health plans to comprehensively address the health care needs of underserved populations. As part of its commitment to improving the lives of its 200,000 members and in response to alarming rates of asthma among the Plan’s target population, NHP introduced its innovative Asthma Disease Management Program (ADMP) in 2000. NHP provides an Asthma Home Visitation Program (AHVP) to all members living with asthma in need of in-depth asthma education and/or home environmental assessment. NHP implemented an Enhanced Asthma Home Visit program in 2005 based on the positive outcomes of a one year Inner City Asthma Study (ICAS) of non-clinician home-based environmental intervention to reduce exposure to environmental triggers and allergens. The AHVP empowers patients to proactively manage their asthma by providing multilingual, low-literacy education to patients and their families during in-home environmental assessments and interventions. In addition, the ADMP helps primary care providers improve asthma care by enhancing programs at primary care sites; using a robust and comprehensive asthma registry; and increasing provider awareness and compliance with asthma treatment guidelines. To further address the appropriate management of asthma, NHP’s website provides access to several provider-focused resources. By collaborating with community-based initiatives, including the Boston Asthma Initiative, the Greater Brockton Asthma Coalition, and State and regional partners, the ADMP’s active leadership strengthens Massachusetts’ community-wide approach to asthma management. Over the past decade, the rates of annual asthma hospitalizations and emergency department visits for Neighborhood Health Plan’s asthma population have fallen by more than 30 percent.