Outcomes associated with a hospital-community program aimed at reducing the burden of asthma among inner-city families

Childhood asthma rates in Northern Manhattan are four times the national average. The complexity and fragmentation of local health systems, combined with conflicts between cultural and clinical values, create significant challenges for this largely foreign-born, low-income community. In 2005, local hospital and community partners applied the principles of community-based participatory research to design and implement the Washington Heights Inwood Network (WIN) for Asthma: a comprehensive program aimed at reducing the burden of asthma in the community. Program goals were to identify families of children with poorly controlled asthma, to increase caregiver self-efficacy, and to reduce preventable asthma-related emergency department (ED) visits, hospitalizations, and missed school days. Families were referred to the program via an established hospital-community communication and referral system. Bilingual community health workers (CHWs) offered family-focused asthma education, addressed household asthma triggers, and linked families to the clinical and social resources required to facilitate effective and sustainable asthma management. Caregiver interviews at baseline, 6 months, and 12 months and descriptive statistics were used to assess the impact of the intervention on caregiver self-efficacy and key asthma morbidity indicators. Over a period of 3 years, CHWs enrolled 360 families of children with poorly controlled asthma. After 12 months in the program, caregiver confidence in controlling their child's asthma increased by 40%, ED and hospitalization rates decreased by more than 50%, and child school absenteeism decreased by 30%. Evaluation results thus demonstrate that a family-centered, community-based asthma prevention program can make a significant impact among high-risk children with asthma.