Children’s Hospital of Richmond at VCU’s You Can Control Asthma Now (UCAN) community asthma program helps children who live in the Richmond, Virginia, metropolitan area where both asthma and poverty rates are disproportionately high. Established in 2015, UCAN has served more than 344 patients using a family-focused case-management approach. Families are typically enrolled following an uncontrolled asthma-related emergency room visit or hospitalization, but can also be referred by their primary care physician or self-refer. UCAN patients are assigned a pulmonologist (lung doctor) who provides comprehensive asthma care, receive asthma education from a nurse, and are provided resources and support to address barriers to treatment following evaluation by a social worker. They receive follow up communication via text and phone calls, and are referred as needed for a Healthy Homes assessment through the City of Richmond Health District. UCAN also collaborates with the Medical Legal Partnership Program to empower families to address environmental housing issues not properly addressed by landlords. UCAN has saved $691 per patient through decreased hospitalizations and emergency room visits – leading to an overall cost reduction of $163,958.
Health Care Provider
Mobile Care Chicago is a not-for-profit organization that uses mobile medical clinics to assist children currently unable to access necessary specialty care for a chronic condition. For 19 years, Mobile Care Chicago has used partnerships with local schools to provide a convenient and trusted location for local children who have complex needs but whose parents may not have the time, transportation or work flexibility to access more distant brick-and-mortar clinics. Mobile Care Chicago currently operates two Asthma Vans for children with severe asthma and/or allergies, a Dental Van for children who need oral surgery, and a Portable Dental Clinic that can be set up inside of schools to make referrals to the Dental Van. In total, Mobile Care Chicago’s mobile clinics serve roughly 8,000 patients per year, seeing the vast majority multiple times per year.
Research suggests that in lower income Chicago neighborhoods, such as Humboldt Park and the South Shore, more than 25% of children have asthma. Chicago has the second-most asthma fatalities of all cities in the United States, according to the Asthma and Allergy Foundation of America. Most fatalities happen in Cook County neighborhoods where asthma is not well-controlled because of lack of available medical care. The Illinois Department of Public Health estimates that 76.5% of children with asthma in Illinois qualify as “not well-controlled, with the vast majority of cases reported in low-income areas.”
Asthma Vans go directly into lower income communities where specialty care access is an issue. The Asthma Vans then provide ongoing medical support to children with asthma, with a focus on adopting the medical care of its patients from their first appointment until the child turns 19 or graduates from high school. The average patient currently stays with their Asthma Van for more than 7 years. Mobile Care Chicago has screened more than 125,000 children for asthma in its 19-year history and provided comprehensive asthma care to more than 12,000 vulnerable children through more than 44,000 patient visits.
In recent years, Mobile Care Chicago has focused on high-intensity interventions for children with the most severe asthma/allergy conditions, including some children who had been cycling through local emergency departments more than 50 times per year. Through a team of nurse practitioners, allergists and community health workers, the Asthma Vans provide a series of home environment assessments, direct medical treatment and therapy, telemedicine and telehealth support for families, on-going education, and a 24-hour hotline staffed by the nurse practitioner team. The 3-year pilot of this high-intensity asthma control method reduced pediatric asthma emergency room visit rates by 84% in one Chicago hospital that previously had one of the highest rates of asthma admittances.
Patients assisted through the Asthma Vans have seen a more than a 50% decrease in school absenteeism and emergency department visits. Last year, only 6% of Asthma Van patients used an emergency room, versus 55% in the year prior to enrollment. The reduction in hospitalization rate alone (19% to 2% for Mobile Care Chicago patients) has saved the local health care system at least $156 million during the past 13 years. In addition, the Illinois Department of Public Health estimates that uncontrolled asthma costs the state of Illinois $15,155 per individual. By contrast, Mobile Care Chicago spent an average of $836 on each patient in the last fiscal year. This represents a 94% savings for each patient whose asthma is controlled.
Mobile Care Chicago’s early intervention screenings and mobile medical care delivery in hard-to-access and low-income communities has encouraged action and change in the surrounding Chicago communities, bringing asthma relief for thousands of children and peace of mind for parents.
The Pediatric Asthma and Allergy Clinic (PAAC) at the Children’s Health Center (CHC) at Zuckerberg San Francisco General Hospital (ZSFGH) is located in the Potrero Hill neighborhood of San Francisco, California. Created in 1999 in response to San Francisco’s unusually high pediatric asthma hospitalization rates, PAAC soon became the first subspecialty clinic housed within the CHC at ZSFGH. Over the years, PAAC has grown to provide comprehensive asthma and allergy care, case management, and focused education for families across San Francisco Department of Public Health (SFDPH) clinics. It also participates in asthma research efforts through its affiliation with the University of California, San Francisco (UCSF). A reflection of its surrounding community, the PAAC population is approximately 62 percent Latino, 18 percent black and 12 percent Asian, with a strong presence of immigrant families from diverse ethnic backgrounds.
As a university-affiliated public hospital serving low-income Hispanic/Latino and African-American children, ZSFGH PAAC was selected by Yes We Can: Creating an Urban Asthma Partnership to develop a comprehensive medical/social model for pediatric asthma care housed within the CHC primary care medical home. This partnership placed community health workers (CHWs) in the center of health care delivery and became the foundation of PAAC clinic services, which have grown to include legal consultation, behavioral health support and housing advocacy.
PAAC aims to provide patients with culturally sensitive and evidence-based asthma and allergy care while treating these patients and working with their families in the context of their environments. The program emphasizes individualized treatment and education, case management and family support, and home and school trigger reduction. The ability to provide quality wraparound services is due in large part to PAAC’s committed staff of physicians, nurse practitioners, nurses, CHWs and community partners. As the clinic has grown, PAAC’s CHWs have spearheaded outreach efforts to the most vulnerable community groups. To increase asthma knowledge and improve access to care, the CHWs provide trainings to foster care parent groups, daycares and schools, public health nurses, and local community organizations. PAAC also is a site of robust research in asthma prevention and intervention through its affiliation with UCSF and SFDPH.
All of PAAC’s efforts have paid off, yielding a 40 percent reduction in asthma hospitalizations in a review of data from 2015 through 2016. Qualitatively, there are many indicators of positive asthma outcomes. The number of caregivers able to appropriately describe controller and rescue medication use, as well as escalation of dose and when to seek appropriate emergency care, during a follow-up phone call at the 2 week interval has increased.
PAAC is increasingly involved in the support and development of local legislation benefiting children with asthma. In the past year, PAAC has contributed to important legislation, including a ban on smoking in public housing and a current bill to allow Medicaid reimbursement for CHWs during home visits and education. PAAC continues to advocate for environmental and social policies that promote a healthy community and a reduction in asthma prevalence.