Community in Action

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.

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.

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.