East Harlem Asthma Center of Excellence: An innovative approach to improved health status for children with poorly controlled asthma

The East Harlem Asthma Center of Excellence was established recently to improve asthma management and control to eliminate asthma as a barrier to normal activities for children in East Harlem, New York City's neighborhood with the highest childhood asthma hospitalization rates. The Center aims to achieve a community-wide impact with a 50% reduction in hospitalization rates.

The Center is based on the CDC-disseminated asthma counselor model and includes the deployment of masters-level asthma case managers to clinical, school and daycare settings. The Center has enhanced that model with multiple components, including 1) an innovative storefront asthma center to provide residents with education and referral services; outreach to schools, daycares and community organizations and training for medical providers to increase adherence to best practices and guidelines; 2) home environmental remediation services addressing pests, molds, tobacco and poor housing conditions 3) expansion of a service provider network to promote integration of services among health care, schools, day care centers, and community organizations, and 4) a web-based asthma case management registry to improve coordination among providers.

The initial 20 cases served by the program have revealed individual/family barriers to optimal asthma management and control as well as numerous system barriers including lack of health insurance or adequate benefits, ready access to quality medical care and insufficient coordination among emergency rooms, primary care, school health programs and managed care organizations. The presentation will include case studies that illustrate these critical individual and system barriers and the strategies the Center has employed to address them.