2019

Omaha Healthy Kids Alliance (OHKA) is a children’s environmental health organization dedicated to improving children’s health through fostering healthy homes. OHKA developed the Asthma In-Home Response (Project AIR) program to serve children ages 18 and younger who have an asthma or asthma-related diagnosis.

Project AIR’s mission is to help reduce in-home hazards for children with asthma in the Omaha metropolitan area. By reducing in-home hazards, AIR works to improve the quality of life for children with asthma and their families by educating them on indoor environmental asthma triggers, empowering positive behavior changes, connecting them with low-cost supportive solutions, and supporting them by providing free construction services. Project AIR aims to reduce emergency department visits and hospitalizations resulting from pediatric asthma, decrease symptomatic days, improve quality of life for children and their families, and increase productivity by reducing asthma-related missed school and work days.

OHKA serves a population that is disproportionately affected by specific health outcomes and faces additional socioeconomic barriers that often take precedence over the intended Project AIR intervention. Most families in Project AIR tend to identify as Black/African American, with the second most frequent racial self-identification being Latino/Hispanic and the third most frequent group being Caucasian. The average household income of Project AIR clients is about $26,000, and the average age of houses that Project AIR families live in is 75 years old. OHKA has a wide network of community partners that assist families with challenges not directly related to their health. Assistance includes help with landlord-tenant disputes, rental assistance, job placement and food pantries. OHKA’s work is successful because of the collaborations and partnerships that have been established to assist in reducing barriers for families enrolled in Project AIR so that they are able to focus on health-related interventions.

OHKA’s Project AIR leverages key partnerships with WellCare of Nebraska (part of the managed care organization, WellCare® Health Plans, Inc.), Children’s Hospital & Medical Center (Omaha), and Boys Town National Research Hospital’s Allergy, Asthma, Immunology and Pediatric Pulmonary Clinics. In addition to formal partnerships, Project AIR provides an assigned asthma case manager, and in-home visits are performed by two OHKA staff who are trained in environmental management and asthma education. After the initial visit, each family receives a Healthy Home Report that is developed by the visiting team. This report includes a description of the home, identified home hazards, low-cost solutions, results of environmental testing and construction, and scopes of work. This document can be shared with physicians, if requested and approved by the family. In addition to a customized environmental supply kit, families often are referred to community organizations for legal and employment services or food pantry access.

Project AIR evaluates the program performance outcomes under four criteria: severity of asthma, quality of life, environmental health of the home, and behavioral changes. To assess how and where the program can be improved, Project AIR also examines internal measures, such as cost per intervention, cost of supplies, follow-up rate and dual-enrollment rate. After 12 months, Project AIR noted a significant decrease in symptomatic days, fewer missed school days, fewer emergency room visits and hospitalization rates, and a decrease in medication usage. Additionally, an evaluation of Project AIR return on investment showed for every $1 invested in a family and their home, a $1.83 return was made.

Project AIR integrates a collaborative approach to asthma intervention and diverse funding sources to create positive change in the Omaha metropolitan area. The program’s success has introduced new partnerships and improved outcomes throughout the asthma community.

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.

Housed within the Rhode Island Department of Health, the mission of the Rhode Island Asthma Control Program (RIACP) is to reduce the overall asthma burden and asthma health disparities in the state. The program provides community-based services and interventions for children 17 years and younger with asthma in four high-poverty, urban “core cities” throughout the state, where the burden of asthma is the highest. The burden of asthma also falls disproportionately on black and Hispanic children, children in low-income households, and children living in low-income urban neighborhoods. These children are not only at high risk of developing asthma but also are at risk of having more severe asthma once the disease develops. Among children living in the core cities, the rate of primary asthma hospitalizations was twice as high compared with the rest of the state.

RIACP is well-known for its long-term partnerships with researchers and hospitals, as well as public health, housing, social justice and environmental organizations across the state, including Hasbro Children’s Hospital, St. Joseph Health Center, the Asthma Regional Council of New England, UnitedHealthcare®, and the Green and Healthy Homes Initiative. Additionally, RIACP’s efforts are focused around a collaborative approach with linkages between healthy housing, the health care sector, and other regional collaborations. RIACP’s work to reduce the asthma burden in Rhode Island is critical for developing, evaluating and sustaining the program’s strategies to expand the reach of its comprehensive asthma services. RIACP was recognized by the Centers for Disease Control and Prevention (CDC) for its reimbursement efforts and participated in the CDC’s 6|18 Initiative. Through this national leadership program, RIACP received CDC technical assistance and Medicaid support to develop a business case for the reimbursement of RIACP’s asthma home-visiting initiative, the Home Asthma Response Program (HARP).

HARP is an evidence-based program established in 2010 to address the needs of children with poorly controlled asthma and uses certified asthma educators (AE-Cs) and community health workers (CHWs) to conduct up to three intensive in-home sessions for each child. During these home visits, AE-Cs and CHWs provide tailored educational and environmental services, including an extensive environmental assessment, asthma self-management education, and cost-effective supplies to reduce home asthma triggers. CHWs have reported reductions in environmental triggers, including mold, pests, dust, pets, tobacco smoke and chemicals. In addition, using hospital claims data, the program was able to show a 75% reduction in asthma-related hospital and emergency department costs for HARP participants. For every $1 invested, HARP participants realized a $1.33 return on investment. The program recently expanded to provide HARP home-visiting services statewide for Medicaid-enrolled children.

In 2015, RIACP and partners launched the Comprehensive Integrated Asthma Care System (CIACS) to link home-based, school-based and health systems interventions as one unified package. HARP became one of four interventions offered, in addition to the Breathe Easy at Home Project, Controlling Asthma in Schools Effectively Project, and Draw A Breath workshop program. These interventions have been implemented in the four core cities, and a CIACS Advisory Group—comprising public health professionals, asthma researchers, a nurse, CHWs, and a data manager—works collaboratively on the implementation and evaluation of asthma services. The CIACS Advisory Group is Rhode Island’s first researcher-practitioner partnership to reduce the burden of asthma in children.

RIACP has been successful in serving children with poorly controlled asthma and reducing these children’s likelihood of repeated asthma emergency department visits and inpatient hospitalizations. RIACP also has also built partnerships with local, statewide, regional and national partners to reduce individual- and neighborhood-level disparities in pediatric asthma.