Home Visits for Children With Asthma Reduce Medicaid Costs.

We conducted a multicomponent, low-cost, home intervention for children with uncontrolled asthma, the Reducing Ethnic/Racial Asthma Disparities in Youth (READY) study, to evaluate its effect on health outcomes and its return on investment. From 2009 through 2014 the study enrolled 289 children aged 2 to 13 years with uncontrolled asthma and their adult caregivers in Boston and Springfield, Massachusetts. Community health workers (CHWs) led in-home asthma management and environmental trigger remediation education over 5 visits spanning 6 months. Asthma health outcomes and indoor environment data were collected via survey, and health use costs were accessed through Massachusetts Medicaid (MassHealth). Results showed significant improvements in asthma control, health care use, and environmental trigger reduction and a positive return on investment (1.34) for participants who had 2 or more emergency department visits 1 year prior to the first home visit. The CHW asthma home visiting intervention improved trigger management, clinical outcomes, and Medicaid cost savings, demonstrating that asthma home visits improve health quality and reduce costs.

An Integrated Approach to Falls Prevention: A Model for Linking Clinical and Community Interventions through the Massachusetts Prevention and Wellness Trust Fund.

Older adult falls continue to be a public health priority across the United States-Massachusetts (MA) being no exception. The MA Prevention and Wellness Trust Fund (PWTF) program within the MA Department of Public Health aims to reduce the physical and economic burdens of chronic health conditions by linking evidence-based clinical care with community intervention programs. The PWTF partnerships that focused on older adult falls prevention integrated the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Death and Injuries toolkit into clinical settings. Partnerships also offer referrals for home safety assessments, Tai Chi, and Matter of Balance programs. This paper describes the PWTF program implementation process involving 49 MA organizations, while highlighting the successes achieved and lessons learned. With the unprecedented expansion of the U.S. Medicare beneficiary population, and the escalating incidence of falls, widespread adoption of effective prevention strategies will become increasingly important for both public health and for controlling healthcare costs. The lessons learned from this PWTF initiative offer insights and recommendations for future falls prevention program development and implementation.

Community Health Worker Integration in Health Care, Public Health, and Policy: A Partnership Model.

Health care systems and public health agencies are focusing increased attention on the capacity of community health workers (CHWs) to improve health outcomes for vulnerable populations and to support integration of clinical and community prevention services. This article describes 3 initiatives in Massachusetts in which the state public health department has collaborated with CHW leaders, health providers, and community-based partners to develop innovative policy and services, including state certification of CHWs, integrated chronic disease programs, and a state-funded pilot program to demonstrate return on investment for community-based prevention. Concluding lessons are relevant for implementation of health care reform nation-wide.

Community-based participatory research in Boston's neighborhoods: A review of asthma case examples.

Three case examples of asthma studies that differ in terms of community and involvement are considered. The Boston Chinatown studies faced limited funding that restricted the level of community involvement, but resulted in some of the first published evidence about asthma in Asian American children. These studies led to an asthma education program grant to a local Asian clinic and elementary school. The public housing study was a well-funded multi-year study of asthma and pest management with city, university and community partners. Residents were trained to collect data and participated throughout the study. Follow up pest management and pesticide buy-back programs headed by the city and community partners have been funded. The Dorchester case had more limited funding, but had the greatest level of involvement of parents of asthmatic children in all phases of the research. This survey led to an interesting novel finding of lower asthma prevalence in foreign born black residents.

Who's sick at school: linking poor school conditions and health disparities for Boston's children.

A recent review of student asthma rates and environmental audits of school buildings suggests that schools with poor indoor air quality have higher-than-average rates of asthma. Many Boston Public School (BPS) children and staff are learning and working in poor indoor environmental conditions that not only can exacerbate asthma, but also lead to other problems ranging from allergies and sinus infections to adverse academic performance [1]. The Boston Urban Asthma Coalition (BUAC) conducted a preliminary analysis of 2004-05 childhood asthma rates for BPS students and compared them to the 2004-05 environmental audits of the top 10 schools with environmental problems. This analysis suggests that schools with the highest rates of leaks, mold, and pest infestations also have higher-than-average asthma rates for children.