Sinai Health System - Asthma CarePartners (ACP) Program

Overview

The Asthma CarePartners (ACP) program is a comprehensive asthma management program for children and adults living with the disease. The program started in summer 2011 when the Sinai Urban Health Institute (SUHI) and Family Health Network (FHN), a Medicaid managed care organization, formed a partnership to provide the program to identified members whose asthma may not be well controlled. ACP is offered at no cost to selected members; its goal is to help adults and children with asthma to improve asthma control so that they may lead more healthy and active lives. The program utilizes community health workers (CHWs) to educate individuals about the disease, triggers, and management in their home. SUHI’s CHW model is well established and has been the key element of asthma interventions since 2000. Four asthma interventions with more than 1,000 participants, rigorous evaluation results, and demonstrated cost savings facilitated SUHI in establishing this unique partnership, allowing for the incorporation of the model within standard health care delivery.

Impact

Six-month preliminary outcomes for children and adults demonstrate an improvement in asthma control, reduction of daytime and nighttime symptom frequency, and a dramatic reduction in asthma-related health resource utilization. When appropriate, referrals are made to the Metropolitan Tenants Organization (MTO) to assist with substandard housing issues that may be highlighted in the environmental assessment. CHWs work closely with staff from MTO to ensure that the issues are addressed. When individuals and families receive sufficient education and medical treatment, it’s possible to live full and active lives with asthma without hospitalizations or frequent visits to the emergency department (ED).

Challenges/success factors

Chicago’s asthma epidemic reveals an even wider disparity in regard to the burden of asthma on poor, inner-city, and minority communities than is seen nationally. African Americans living in Chicago are nearly eight times more likely to die from asthma than residents of white neighborhoods. Non-Hispanic black persons living in Chicago make ED visits due to their asthma at an age-adjusted rate that is more than nine times greater than that of their non-Hispanic white counterparts. Additionally, asthma-related hospitalizations are nearly six times more common in African Americans than in Caucasians.

The cost for private insurance companies and Medicaid-funded providers is enormous: an average ED visit for children and adults is $691, while hospitalizations for children average $7,897 and for adults $9,261. Preventing these costs by educating and empowering those with asthma makes economic sense and significantly impacts the quality of patients’ lives and that of their families.

Participants in the ACP program have seen urgent care clinic and ED visits decrease on average by 82.2 percent and 75.8 percent, respectively. Hospitalizations have been similarly reduced by 82.1 percent. On average, the program increases a participant’s asthma symptom-free days by 99 days per year. The number of days within two weeks that children used their rescue medication decreased from 5.4 before the intervention to 3.5 times on average during the intervention. Similarly, nights on which sleep was disturbed by asthma decreased by 65 percent.

Future direction/sustainability

SUHI continues to work with FHN to bring the ACP program to selected children and adults whose asthma is not well controlled. Participants receive six home visits and monthly phone calls in the year-long intervention, where they expand their knowledge and understanding of asthma through education and hands-on demonstration of proper medical device technique. Given the positive outcomes and potential cost savings that have been demonstrated thus far, FHN is continuing to provide the program to their members in need. Since a person’s home environment has a significant impact on the health of someone with asthma, an environmental home assessment is a critical aspect of the program and of helping participants to positively impact their health.

Advice to others

ACP incorporates a home-based comprehensive asthma CHW intervention within the standard health care delivery system. This successful partnership with FHN is the key to the program’s success and ability to impact children, families, and adults. In addition, SUHI’s long-term partnership with MTO has addressed the intricacies of housing issues and how they can adversely impact one’s health. Utilizing evidence-based interventions as the basis for a program within the health care system is essential. Trust and communication that can produce a shared vision, mission, and goals among partner organizations and participants are also critical to program success. SUHI plans to expand the ACP program to additional health care management organizations, accountable care organizations, and independent physician associations. Given the reductions in health care utilization and resulting cost savings, it is believed that organizations with financial risk tied to patient disease management will be eager to provide such an intervention to their members with uncontrolled asthma.

Contact: Julie Kuhn
Supervisor of Program Initiatives
Sinai Urban Health Institute
Telephone: 773-257-2621
E-mail: Julie.Kuhn@sinai.org