Practice Title: Managing Asthma Triggers at Home: A collaborative effort
Department: ARAQMD Summit County Public Health (SCPH), www.scph.org, is a local health department located in Akron, Ohio. SCPH provides a multitude of clinical, environmental and community health services to the residents of Summit County to protect and promote the health of the entire community. One of the programs provided by SCPH includes the Akron Regional Air Quality Management District (ARAQMD), the local air agency covering Summit, Medina and Portage Counties. ARAQMD is contracted to the Ohio EPA to do air pollution regulation, but being a part of SCPH, ARAQMD is able to expand duties to affect other public health issues. One of those expansions is the indoor air quality program. Offering consultation and educational services to the public about the indoor environment to thousands of people since its inception in 1993, the indoor air program has been a benefit to those who contact us. This three county region has a 2019 population of 883,225 according to the US Census Bureau. The population of the area is primarily Caucasian (84%) and secondarily African-American (10%). In this region, 20.6% of the population is under the age of 18. Nationally, asthma has been identified as a health disparity for African-American children as 12.7% of that community are affected by asthma, as compared to 8% of Caucasian children (Forno, 2012). This effect has been identified in Ohio as well. Ohio Department of Health states that “asthma-related visits to hospital emergency departments are 4 times higher and asthma-related hospital admissions are 5 times higher among black children than white children” (ODH, 2018). The 2016 Akron Children’s Hospital (ACH) Community Health Needs Assessment has asthma “identified as a significant health issue by focus group participants in Summit and Wayne Counties as well as by the Akron Children’s Hospital Internal team of medical leaders and hospital administrators” (Akron Children’s Hospital, 2016). Childhood asthma was also identified as a significant issue by SCPH in the 2017 Community Health Improvement Plan and the creation of a plan to reduce the burden of childhood asthma through community level interventions was proposed (SCPH, 2017). In their 2019 report, the Asthma and Allergy Foundation of America identified the Akron area as the 14th worst place in America to live for those with asthma (AAFA, 2019). In 2017, SCPH began training ACH Community Health Workers to identify asthma triggers in the home. This training used materials that targeted the housing stock and issues found here in the region and was provided to 30 CHWs. The CHWs were able to use this training to identify environmental triggers and hazards in the homes of their clients. However, in early 2018, the Akron area lost a small child to asthma. It was decided that a more robust program should be created and implemented to help children with high risk asthma to reduce their need for hospitalization and emergency room utilization. In 2018, SCPH partnered with ACH to create the Managing Asthma Triggers at Home (MATH) program. This collaborative program recognizes that children with high risk asthma can suffer an acute attack, go to the hospital, get the necessary medical attention to address their needs, be released to go home and get triggered again. ACH has an established high risk asthma list of roughly 3,000 children between the ages of 2 and 18 years old. To be included on the list, the child had to have been intubated once, hospitalized twice, or been to the emergency department for asthma in the last 12 months. These are the children we wanted to address in the MATH program. While ACH gets these patients stabilized while at the hospital, when they are sent home, there are environmental triggers in the home that can re-ignite the asthma flare up and send the child back to the hospital. SCPH has trained staff that can go into the home and identify those triggers and educate the family to reduce the child’s exposure to them. With the MATH program, SCPH also provided a suite of intervention equipment to help reduce exposures to environmental triggers. Research shows that individually education, trigger reduction and medical treatment will provide improvements in asthma incidents, a combination of all three will be best. (Cook, 2017, GHHI, 2019) The goal of the MATH program was to create a pilot project to validate the research (Leas, 2018, Pakhale 2011, Cook, 2017) which said that the combination of the intervention equipment for trigger reduction, education and medical treatment would benefit the clients in a synergistic manner. Secondary goals of the program were to cement relationships between the hospital, the health department and the local metropolitan housing authority to better serve children suffering with asthma and also to begin working with insurance companies to begin covering the expense of the trigger reducing equipment. The collaborative decided that a cohort of 50 clients would be a manageable size for each year, and that the hospitalization usage would be tracked for the year prior to, during and following engagement in the program. Quarterly home visits and Asthma Control Test (ACT) scores were also tracked during the one year of engagement. Over the first year, the program enrolled 50 clients and tracked ACT scores, emergency room visits due to asthma and hospitalizations due to asthma. It was determined that a second year of data would be useful, so the program was extended into a second cohort. The results were positive, showing a decline in emergency room visits and hospitalizations, an increase in ACT scores and anecdotal evidence showing that the program was beneficial to the families. During the second year, SCPH and ACH began work with the Akron Metropolitan Housing Authority (AMHA) focusing on their asthmatic clientele. SCPH also began discussions with Medicaid payers who have MATH clients about creating sustainable funding for the program. The success of the collaboration was due to the universal acknowledgement of asthma as an important public health issue, the desire of the partners to assist these clients in improving their lives and the availability of funding to make the program possible.
Size: Large (Population of 500,000+ people)
State: Ohio
Summary of Practice:
Managing Asthma Triggers at Home: A collaborative effort
Category
Healthy Living and Prevention
Description