Asthma CarePartners: Embedding an Innovative Community Health Worker Program into Standard Healthcare Delivery

The Asthma CarePartners (ACP) program is an innovative partnership between the Sinai Urban Health Institute (SUHI) and Family Health Network (FHN), a Medicaid managed care organization.  Four previous SUHI asthma interventions with rigorous evaluation results and demonstrated cost savings have proven the effectiveness of the Community Health Worker (CHW) model, culminating in ACP.  The program incorporates the model within standard healthcare delivery, and aims to improve asthma management among FHN members with asthma who have evidence of poor control. 

 FHN members are referred into the ACP program by case managers.  Participants receive six home visits during a year-long intervention.  CHWs support participants, reinforcing or expanding their knowledge and understanding of asthma through comprehensive, individualized education and hands-on demonstration of proper medical device technique.  Since the home environment has a significant impact on the health of someone with asthma, an environmental home-assessment is a critical aspect of the program.  CHWs work collaboratively with families to reduce the presence and effect of environmental asthma triggers.  In addition, CHWs communicate regularly with primary care physicians (PCP) regarding participants’ Asthma Action Plans and medication-related issues and encourage participants to visit their PCP regularly.

Since the program began on 8/16/2011, 302 participants have completed a baseline visit.  Among the 66 participants who have completed the 12-month intervention to date, healthcare utilization has been dramatically and significantly reduced, with a 73% reduction in emergency department visits (p<0.0001) and a 75% reduction in hospitalizations (p=.007) between the year prior to and the year following the intervention.  Findings regarding urgent health resource utilization support the assertion that the program is resulting in significant healthcare cost-savings, estimated at $3,200 saved per patient/year over costs incurred during the baseline year. This translates to $5.79 saved per dollar spent on the intervention.  Furthermore, nights where sleep was disturbed by asthma over a two-week period was decreased from 6.8 nights at baseline to an average of 2.3 over the intervention period (p<0.0001).  Caregiver Asthma-Related Quality of Life scores improved from 5.0 to 6.6 at the 12-month follow-up (p<0.0001), a clinically and statistically significant improvement.

Data demonstrate an improvement in asthma control, reduction in symptom frequency and enormous reduction in asthma-related health resource utilization. Embedding a CHW home visit asthma intervention into managed care delivery yields cost-savings for the healthcare system and life-changing benefits for participants.