Children's Hospital Boston Community Asthma Initiative: Reducing Health Disparities in Boston ( as part of the proposed panel REACHing for Social Justice: Highlights of REACH Programs Working to Advance Health Equity)

Objective: Because asthma is the leading cause of hospitalization at Children's Hospital Boston, the Community Asthma Initiative (CAI) was developed to provide nurse case management, home visits, and community connections to reduce health disparities for children with asthma in Boston.

Methods: Services provided included nurse case management for an individualized care plan, coordination with primary care, allergist, and community resources; and home visits, including environmental assessment, integrated pest management, and asthma education. In the first four years of the program, baseline and 12-month follow-up questionnaires were completed. Data analysis included the McNemar's test for dichotomous variables and paired t-test for continuous variables to assess hospitalizations, emergency department (ED) visits and missed school/work days.

Results: This CDC REACH US program served 441 children with a mean age of 7.8 years old (+ 4.5 SD); 53.7% males; 47.8% African American, 44.8% Latino, 7.4% other. There were significant reductions in hospitalizations (81%), ED visits (65%), missed school days (39%), missed work days (49%), and a 71% increase in the number of children with a current asthma action plan (all p<0.001). The program has been successful implementing Community and Family Advisory Boards. This model of asthma care is generating information that is used for planning, advocacy, and policy efforts to reduce asthma health disparities.

Conclusion: CAI significantly decreased admissions, ED visits, missed school and missed work days at 12 months of follow-up, and provides a successful model of asthma care that can be replicated nationally and influence policy to address social determinants of health.