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What is a peak flow meter? Do you know how to use a spacer? These may be unfamiliar items for people without asthma, but standard for the more than 140,000 children in Massachusetts being treated for the disease.
Asthma is particularly prevalent in low-income areas and among Latino and Black children. At Children's Hospital Boston, asthma is the leading cause of hospitalization. Overall, the rates of admission for Latino and Black children are five times higher than for white children.
Tackling asthma among these vulnerable populations is the mission of the Community Asthma Initiative (CAI), the hospital's program for improving asthma management for children and families living in Jamaica Plain and Roxbury. The program's director, Elizabeth R. Woods, MD, MPH, says, "Asthma takes a toll on children and families. It can interfere with a child's ability to do everyday things, like sleeping, playing and going to school. And when a sick child can't go to school, a parent can't go to work." This ongoing loss of productivity adds 'economic' and 'financial' to the long list of how this disease can burden families.
Key goals for the CAI are preventing asthma attacks and controlling the disease by working on three fronts:
• Nurse case management and home visits for patients and their families. CAI provides family-centered and individualized asthma plans (in English and Spanish); home visits, in partnership with the Boston Asthma Initiative, help families identify and lessen asthma triggers; and education about asthma and how to better manage medications. Case management also helps families make connections with primary care physicians, access allergy evaluations, receive insurance coverage, find support to deal with housing issues, such as pest management concerns, and identify community resources.
• Community education for families. CAI also offers educational workshops and events that engage the entire community-families, schools, community health centers, advocacy groups and community-based organizations. The program trains staff at community health centers, schools and in other community organizations to increase their capacity to provide asthma education and recommend appropriate physical activities for children. All these efforts promote the treatment of a child in the context of their environment and everyday life.
• Local, regional, and national advocacy efforts in partnership with a 16-member family advisory board and other partners. One such partnership resulted in a "business case" that measured the value and savings that can result from case management and home visits, a first step in getting insurers to cover these services. Based on the results of this work, legislation was filed in 2008 to ensure payer coverage for asthma education and in-home environmental interventions.
The hospital is measuring success for CAI by looking at its impact on reducing the number of asthma-related emergency department visits and hospital admissions. Has the program worked? "Absolutely," says Woods. "We are very pleased with the results so far." For children participating in the program after one year, the number of emergency department visits at Children's was reduced by 67 percent and hospital admissions by 84 percent. In addition, lost school days were reduced by 53 percent and parents' missed work days by 49 percent.
"We've made great progress, but there's so much more to be done," says Woods. "We must continue to push for reimbursement for this approach and help build community capacity to manage similar programs. It could take years to achieve our vision, but we are well positioned to decrease the burden of asthma."
For more information on CAI or to access a copy of the asthma business case, visit childrenshospital.org/communityhealth.
Children's is the largest provider of health-related services to children with asthma in Massachusetts. More than 17,650 inpatient and outpatient visits were recorded in FY 2008 for 9,453 patients for whom asthma was a primary or complicating diagnosis. In addition, more than 500 children - along with their families and caregivers - were served through community initiatives and hundreds more reached through the hospital's participation in local health fairs and other community events.
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