Online Program

Boston children's hospital community asthma initiative: QI evaluation of an enhanced care program including workforce development

Wednesday, November 6, 2013

Elizabeth R. Woods, MD, MPH, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Susan J. Sommer, MSN, WHNP-BC, AE-C, Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Urmi Bhaumik, MBBS, MS, ScD, Office of Community Health, Boston Children's Hospital, Boston, MA
Lindsay Tsopelas, BA, Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Margarita Lorenzi, BS, Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
Eric Fleegler, MD MPH, Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA
Deborah Dickerson, BA, Office of Child Advocacy, Boston Children's Hospital, Boston, MA
Shari Nethersole, MD, Boston Children's Hospital, Boston, MA
Objective: The Community Asthma Initiative (CAI) provides case management and home visiting by nurses and community health workers (CHW) for children with poorly controlled asthma.

Methods: Home visits include asthma education, environmental assessment, Integrated Pest Management, and connection to community resources. Data collected over the past 7 years included Emergency Department (ED) visits, hospitalizations; and days of missed school and parent/caregiver work. McNemar's test was used for dichotomous variables, and paired t-tests and General Linear Model repeated measures for continuous variables. Geographic information systems (GIS) data analyzed neighborhood risk factors. Program cost per patient and CAI expansion efforts were tracked.

Results: To date, 986 children were enrolled: 56.0% male; 45.1% Black, 47.3% Hispanic; 72.4% Medicaid; 65.3% household income <$5,000. From parental reports at 12 months compared to baseline, there were significant reductions in patients with any (≥1) hospitalizations (80%), ED visits (56%); and days of missed school (42%) and missed parent/caregiver work (47%) (all p<0.001). GIS mapping showed the majority of patients (65.8%) live in the poorest neighborhoods that are predominantly Black or Hispanic (74%). Home assessments showed that 84.4% had environmental triggers. Total program cost per patient has decreased from $2,600 in FY09 to $2,310 in FY12. A CHW home visiting model with nurse supervision is being tested regionally and nationally with workforce expansion through a local Home Visit Collaborative, regional New England collaborative, and replication in a Southern state.

Conclusion: CAI has improved health outcomes. Expansion of the public health workforce is required for community-based asthma home visiting.

Learning Areas:

Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Program planning
Public health or related education
Public health or related research

Learning Objectives:
Describe the Community Asthma Initiative model and the needs for workforce development.

Keyword(s): Asthma, Home Visiting

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Professor of Pediatrics at Harvard Medical School, the Associate Chief of the Division of Adolescent/Young Adult Medicine, Director of the Community Asthma Initiative (2005-present), and Chair of the Asthma Quality Improvement Committees at Boston Children’s Hospital. I have been seeing patients for over 25 years. I have authored over 96 original publications, authoritative reviews and chapters in the areas of quality improvement, health services research, program development and evaluation, and asthma care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.