2009

The Seton Family of Hospitals formed the Seton Asthma Center in 2004 to respond to a rise in asthma-related pediatric emergency department visits and hospitalizations, especially among economically disadvantaged and underserved populations. The Center’s case management workers, all registered respiratory therapists, promote improved patient self-management in bilingual patient education sessions that include in-home environmental assessments, training on appropriate use of medications and peak flow meters, and the development of personalized asthma action plans. The asthma action plan serves as a communication tool between the primary care provider, the school nurse, and the patient. The case managers review each asthma action plan quarterly to ensure each patient has a current, effective plan in place. The Center also operates a mobile caravan that makes monthly visits to public schools to deliver asthma care to uninsured and indigent students. Case managers have partnered with the Central Texas Asthma Coalition and the American Lung Association’s Lung Health Initiatives Committee to raise public awareness, educate providers, and collect surveillance data. This partnership has led to the use of a standardized set of metrics to assess the burden of asthma in the community. For patients enrolled in the program, asthma-related emergency department visits have dropped by 75 percent, and the number of in-patient visits has decreased by 85 percent.

Focused on inner-city children in the Flint, Michigan area, the Genesee County Asthma Network (GCAN) is a comprehensive community-based program that delivers high quality asthma care through asthma and allergy specialists, physicians, and two registered nurses who are certified asthma educators. The asthma educators complete up to 200 home assessments each year where they identify asthma triggers, while an accompanying social worker identifies potential barriers to successful asthma management such as financial hardship, transportation, or family issues. Incentives and awards motivate patients and families to follow through with self-management advice. Classroom assessments (that identify and encourage schools to fix environmental problems) often complement home inspections and ensure that patients are well prepared to address their environmental asthma triggers. Asthma educators accompany patients on clinical visits to review medications and help develop a personalized asthma action plan. With the support of Hurley Medical Center and working with numerous partners in the community— including the American Lung Association, faith-based organizations, health providers and payers, and Habitat for Humanity, which built an asthma-friendly home for one patient’s family—GCAN has produced dramatic results. Asthma-related emergency department visits have dropped by 45 percent; hospitalizations by 25 percent.

Serving nearly 38 million people, the California Department of Public Health - Center for Chronic Disease Prevention and Health Promotion provides multi-faceted asthma management and care to children and adults through programs based in schools, workplaces, and the community at large. The Work-Related Asthma Prevention Program provides customized educational materials to underserved adults with workplace-related asthma, analyzes data to identify high-risk industries and appropriate interventions, and conducts site investigations. The California Breathing Program conducts school-based programs that emphasize environmental interventions, train staff and childcare providers, and offer incentive-based awards to schools that create healthy environments. Community-based grants to local organizations fund a range of interventions including technical assistance on topics such as pest management in housing developments, second-hand smoke reduction, and mold intrusion training for code enforcers. Environmental interventions are complemented by the California Asthma Public Health Initiative where clinicians assess individual allergen sensitivities, educate families, and often provide free products to reduce exposure to triggers. In participating clinics, the number of children with written asthma action plans increased 84 percent, and asthma-related emergency department visits dropped by 78 percent.

Staffed by pulmonologists, allergists, public health staff, and an extensive translation services program—with over 30 languages spoken—Boston Medical Center’s (BMC) collaboration with the Boston Public Health Commission (BPHC) provides excellent clinical and environmental care and promotes improved asthma self-management for the city’s underserved populations. The program educates patients about asthma management and environmental triggers, facilitates access to needed services (medical legal partnership, housing, and insurance), and promotes strong provider-patient relationships that contribute to improved patient outcomes. BMC’s environmental focus includes partnerships with several Boston agencies to launch the Breathe Easy at Home Program, a Web-facilitated program that gives health professionals a way to report potential housing code violations that may worsen patient asthma, and the Boston Inspectional Services Department responds to reports by working with property owners to remediate the situation. In striving to offer effective and accessible primary care and outpatient services, BMC successfully works with their most utilized health plans to provide asthma education and case management services and provides exceptional care without exception. The city of Boston is reaping the benefits of this powerful collaboration. The hospitalization rate for Boston’s children with asthma has decreased 39 percent and emergency department visits are 16 percent lower.

Based on the premise that strong patient-provider interaction is key to asthma management, the Bethlehem Partnership for a Healthy Community identifies and educates high-risk children and their families through the school system, improves access to preventive services and care, and provides up-to-date asthma education to the medical community. In partnership with St. Luke’s Hospital and the Bethlehem Area School District, the initiative helps to manage asthma through multiple access points: school-based health clinics, Open Airways Programs, mobile school health clinics, and St. Luke’s Hospital Clinic. The program educates and supports clinical care teams by providing annual education and training to health care providers and coalition partners. Patient education includes multiple, bilingual home visits and thorough patient follow-up. Working with the Bethlehem Health Bureau, the initiative evaluates homes for environmental triggers while distributing trigger-reducing items (such as mattress covers and green cleaning supplies), provides one-on-one education to families, and assists tenants in contacting landlords in order to correct mold and cockroach issues. Through a successful partnership with Lehigh University, the program expanded to address outdoor air quality during the home visit survey. The initiative has proven to be effective: From 2007-2008, multiple asthma-related pediatric emergency department visits for individual patients decreased by 56 percent.