Community Asthma Initiative, Children’s Hospital Boston

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).