2010

Twelve years ago, the Woodhull North Brooklyn Health Network implemented its comprehensive, evidence-based asthma management program to ensure best practices for asthma care were used to treat all asthma patients. By educating and training health care providers, community organizations and schools, Woodhull has taken a multi-faceted approach to improving asthma care in one of the nation’s highest-risk communities for asthma. At the center of this approach is the Network’s leadership in heading the North Brooklyn Asthma Action Alliance, a coalition that partners with national organizations, community groups and health care facilities to deliver a high standard of asthma care to the community. Supporting this work, the program trains doctors, nurses and hospital residents with its PACE program, which aligns with the National Institutes of Health Guidelines for Asthma Care, and utilizes a modified Electronic Health Record to ensure that all of Woodhull’s providers deliver Guidelines-based care. In partnership with Rutgers University, Woodhull performs ground-breaking education on environmental triggers to schools, including the distribution of checklists and diagrams outlining the process to eliminate common triggers. Woodhull also addresses patients’ home environments, distributing environmental control products such as allergen-proof pillow and mattress covers free of charge. Woodhull has renovated the emergency department with a state-of-the-art asthma treatment room, which offers patients assistance with their paperwork while they begin treatment.

This fast-track approach has resulted in easier and more effective access to asthma treatment in emergency situations. The results of Woodhull’s work are captured in its Asthma Registry: The number of visits to the pediatric asthma clinic more than doubled between 2008 and 2009, which correlated to a 58 percent reduction in asthma-related emergency department visits and 67 percent decrease in hospitalizations.

In 2005, a local hospital and community partners applied the principles of community- based participatory research to develop the Washington Heights Inwood Network (WIN) for Asthma. This comprehensive program is designed to facilitate effective and sustainable asthma management in Northern Manhattan, a community with childhood asthma rates that are four times the national average. WIN is a multi-level, community-driven program that enhances case identification and follow-up for children. Through collaboration with key partners, including local day care centers, schools, clinics and community-based organizations, WIN provides community-wide asthma screening and education. Once families are enrolled in the program, bilingual community health workers offer family-focused asthma education, address household triggers, and link families to the clinical and social resources needed to facilitate effective and sustainable asthma management. By engaging and supporting local providers through the delivery of the evidence-based intervention, Physician Asthma Care Education (PACE), WIN works to ensure providers adhere to the latest asthma guidelines, resulting in improved quality of care. Through a partnership with the National Initiative for Children’s Healthcare Quality, WIN developed a comprehensive protocol for post-PACE provider support involving practice-based support. Through collaboration with multiple hospital divisions, the launch of a grassroots marketing campaign, and the development of a long-term business plan, WIN has worked to increase its visibility and successfully sustain its program. WIN’s program success is demonstrated in data collected from Community Health Workers (CHWs): Over a 3-year period, the number of asthma related emergency department visits and hospitalizations decreased by more than 50 percent; caregivers’ confidence in controlling their children’s asthma increased by 40 percent; and asthma-related school absenteeism decreased by 30 percent.

Since 2000, the Sinai Urban Health Institute (SUHI) and Sinai Children’s Hospital (SCH) have partnered to reduce the burden of asthma on vulnerable Chicago communities. As many as one in four children living in the communities served by the Sinai Health System suffer from asthma, as revealed by the Sinai Improving Community Health Survey. Recognizing the disproportionate asthma burden faced by these communities, a series of four comprehensive asthma interventions have been conducted over the past 10 years. Each of these initiatives has focused on decreasing asthma-related morbidity and improving participants’ quality of life by utilizing Community Health Workers (CHW)— members of the community trained to deliver case-specific asthma education through home visits. With funding from the U.S. Centers for Disease Control and Prevention, SUHI and SCH initiated a comprehensive, multifaceted program in September 2008, called Healthy Home, Healthy Child: The Westside Children’s Asthma Partnership (HHHC). This unique program draws from the strengths of its collaborations with partner organizations and community members to address medical, social and environmental factors of asthma. At the heart of this program is the CHW, who provides one-on-one asthma education and environmental trigger reduction counseling to families in their homes. The CHWs also serve as a liaison between the family and medical system. Cost savings analyses and evaluations of these programs have enabled SUHI to demonstrate the approach’s value, proving that the program was a wise investment. Since the inception of the SUHI Pediatric Asthma Programs, there has been on average a 50 percent reduction in frequency of symptoms experienced by children (50.4 percent – 63.6 percent) and significant declines in asthma-related emergency department visits (47.6 percent – 73.5 percent) and hospitalizations (50.0 percent – 81.0 percent). In addition, the SUHI Pediatric Asthma Model has been replicated in other areas around Illinois.