“We have huge racial and ethnic health disparities in our community and we really have to find ways of working with families…to help address the environmental factors that make asthma worse.”
Margaret Reid, R.N., B.A., Director, Division of Healthy Homes and Community Supports, Boston Public Health Commission (Boston, MA)
Margaret Reid, R.N., B.A., Boston Public Health Commission, describes her project's work in demonstrating the value of home visits to improve outcomes for children who have asthma.
Nathalie Bazil, BPHC Health Educator, demonstrates use of a spacer with mask at an asthma home visit in Boston, MA.
The Boston Asthma Home Visit Collaborative of the Boston Public Health Commission (BPHC) worked to demonstrate the effectiveness of a home visiting model that facilitated referrals, service delivery, and payment as a key strategy for improving asthma outcomes while reducing costs associated with urgent and emergency care. It trained community health workers to conduct in-home asthma education and environmental services with patients and their families, particularly in low-income racial, ethnic, and linguistic minority communities.
An online referral and follow-up system, fully accessible to both clinicians and public health officials, contributed to continuity of care and ongoing program improvement. Project components included a training curriculum, forms, protocols, patient handouts, and strategies for reimbursement.
The project also facilitated communication with primary care providers, school nurses, and asthma care managers in the patients' medical homes. In addition, it worked with public and affordable housing landlords to maintain smoke-free, pest-free, healthy home environments.
The BPHC worked with a multi-sector partnership of health care systems, community based programs, public health agencies, and health insurers to engage patients and providers and to review and disseminate project results. While the project operated on a citywide basis, it has potential for replication across the state, and nationally.
Demonstrate the effectiveness of a citywide asthma home visiting intervention.
Provide home-based asthma education and environmental services with trained community health workers.
Develop an online referral and follow-up system fully accessible to both clinicians and public health officials.
Challenges & Solutions
Challenge: Getting in the door. Despite strong recruitment and a clear plan for delivering asthma education and environmental services over the course of three home visits, BPHC identified early on that a number of recruited patients were not receiving the full number of home visits available to them. In some cases, referrals did not translate into a first home visit. In other cases, scheduling and completing the second home visit proved to be the challenge.
Solution: Consulting an expert panel. BPHC conducted a series of strategy sessions with clinical, community, and advocacy partners and payers to help identify ways to address these hurdles. The consultation led BPHC to:
Encourage clinicians and care coordinators to emphasize the importance of the home visits to patients;
Identify a communication liaison in each clinical site—generally, an asthma nurse or chronic disease coordinator—to facilitate referrals and ongoing communication between home visitors and clinicians; and
Set specific targets to reduce time between referrals, initial contacts, and home visits, and to monitor progress of those target goals.
BPHC reached close to 200 low-income Boston children with poorly controlled asthma through its NACI project.
The project required clinicians to include an Asthma Action Plan with a client referral. This practice reinforced the importance of Asthma Action Plans to clinicians.
BPHC shared and collaborated with additional NACI-funded projects to advance asthma care best practices. For example:
BPHC engaged clinicians from Dorchester House Multi-Service Center in referring patients for home visits. BPHC also used feedback provided by Dorchester House Multi-Service Center and other referring organizations to help refine its home visiting protocols, forms, and processes.
To meet its project goals, BPHC used home-visit interventions and focused on communities affected by asthma disparities.
Other NACI-funded projects that used BPHC-type approaches are: