Sahru Cowans, BA¹, Gail Herrick, PHN, MPH², Karen Cohn, MS, CIH³, M. Patricia Perkins, MS, MPH⁴, David Lo, BA: CHW⁵, Leticia Medina, BA:CHW³, and Vicki Legion¹. (1) Community Health Works of SF/YES WE CAN, San Francisco State University, Department of Health Education, 1600 Holloway Ave, San Francisco, CA 94132, 415-405-0470, sahru@sfsu.edu, (2) Occupational and Environmental Health Section, Children’s Environmental Health Promotion Program, San Francisco Department of Public Health, 1390 Market Street, #230, San Francisco, CA 94102, (3) Occupational and Environmental Health Section, Children’s Environmental Health Promotion Program, San Francisco Department of Public Health, 1390 Market Street, #230, San Francisco, CA 94102, (4) Health Education/Community Health Works/RHORC, San Francisco State University, 1600 Holloway Ave HSS 301, San Francisco, CA 94132, (5) Occupational and Environmental Health Section Children’s Environmental Health Promotion Program, San Francisco Department of Public Health, 1390 Market Street, #230, San Francisco, CA 94102

For the four-year period 7/1/00-6/30/04, our team participated in a multi-site clinical and epidemiological study of pediatric asthma in children 0-5, which emphasized community health worker (CHW) asthma education and improvement of environmental triggers. Funded by California tobacco tax revenue, this program identified children from clinic-based settings with ICD-9 coded asthma diagnoses, including urgent care and emergency department (ED) referrals, and community social-service based referrals. Referrals included: community clinicians, and children with presumptive symptoms referred from: day care, pre-school, Head Start, WIC programs, and community health fairs. Home based case management services—including environmental education and remediation assistance--were provided by trained CHWs to all referrals, with nurse and physician clinical care provided to all clinic-based cases. Our CHWs noted far higher rates of loss-to-follow-up (LFU) among community referrals than clinic based referrals. Initial data analysis of 49 LFU cases revealed that 40% of the community-based and urgent care referrals appeared for asthma exacerbations two or more times within the urgent care and emergency room in the six-month period following LFU, suggesting room for improved identification and education within the ED/urgent care setting. We established a computerized system to review all referrals based on consistent (three or more times) locator address and phone data present in hospital registry, which has been incorporated into tracking potentially more difficult-to-reach referrals. We will describe and review this triage system, present data findings, and our CHWs will suggest obstacles to implementation in our and other urban community based settings.

Learning Objectives: