The U.S. Environmental Protection Agency (EPA) is committed to improving the lives of people with asthma by integrating sound science into effective public health programs. In partnership with other federal agencies and nonprofit organizations, EPA delivers a national, multi-faceted education and outreach initiative to increase public awareness and action to manage environmental asthma triggers as part of comprehensive asthma management. An important component of this initiative is the recognition of exemplary programs and community leaders so that they may serve as national models and mentors for community asthma care improvement. The National Environmental Leadership Award in Asthma Management celebrates the outstanding programs and leaders who are improving the lives of people with asthma by delivering strong environmental asthma management as part of their comprehensive asthma care services.
2012 Award Winners
- Health Plan
- Health Care Provider
- Community in Action
Health Plan
L.A. Care Health Plan
L.A. Care Health Plan established the comprehensive disease management program LA Cares About Asthma® in 2003.
L.A. Care selected asthma as a disease management focus because of the large number of members with asthma enrolled in L.A. Care and the success of programs like these in helping patients with chronic illness improve their health status over the course of the disease. LA Cares About Asthma® is a collaborative program designed to improve member self-management through education, empowerment, monitoring and member input and communication.
Pictured l-r: Johanna Aceves, Johanna Kichaven, Rachel Martinez, Joanne Wei, Melissa Diaz, Hela Mahgerefteh, Laura Linebach, Lisa Diaz, and Devaki Magee.
On a monthly basis, LA Cares About Asthma® identifies health plan members with asthma and provides them with a variety of educational materials and tools to help them take control and manage their disease. To be inclusive to its community's needs, the program ensures that linguistically and culturally appropriate materials are available for all potential enrollees.
LA Cares About Asthma® also partners with several community-based organizations to expand its reach and depth to serve individuals most in-need. An in-home visitation program with Long Beach Alliance for Children with Asthma in the Los Angeles South Bay area and specialist referrals with Harbor-UCLA Medical foundation Inc., throughout Los Angeles County offered to high-risk members with asthma are just two examples of such successful partnerships.
Thanks to these efforts, LA Cares About Asthma® achieved a member satisfaction of 97.6 percent, which exceeded their 2011 goal. In particular, members reported great satisfaction with the program materials and felt the materials educated them on how to control their asthma.
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Health Care Provider
Mission Children's Hospital
Mission Children's Hospital serves the 21 most rural and isolated counties in North Carolina. This area's diverse minority population faces some of the greatest health disparities in the state, and further, the majority of Mission Children's Hospital patients are uninsured or underinsured. Pediatric asthma, unsurprisingly, is one of these disparate health concerns.
The Regional Asthma Disease Management Program at Mission Children's Hospital
Pictured l-r: Don Russell, M.D., Supervising Physician; Shawn Henderson, Practice Manager, Mission Children's Hospital; Melinda Shuler, Regional Clinical Coordinator/ Principal Investigator; Amy Trees, Case Manager; Helen Thingvoll, Office Specialist
Through an innovative and bold approach designed to meet the unique needs of this population and to impact minority children suffering from asthma in a significant way, Mission Hospital developed the Regional Asthma Disease Management Program (RADMP).
RADMP confronts these issues at the root of the problem — taking the clinical approach to asthma management and control into non-clinical settings, such as homes, schools and other care facilities in outlying areas. The program addresses social determinants of health, medical and environmental management, education on asthma and environmental triggers, and comprehensive care through an ever-expanding network of invested stakeholders and agencies.
In order to reach minority and low-literacy populations, RADMP utilizes population specific outreach materials and interpretive services. For low-income families, the program offers access through Mission's Medication Assistance Program for asthma medications. Home remediation to eliminate environmental exposures is provided through RADMP's strong network of community partners.
In 2008, the program was recognized as one of the state's top three asthma disease management programs. In 2009, RADMP received a two-year demonstration project grant from the National Heart, Lung, and Blood Institute (NHLBI), as part of the National Asthma Control Initiative. Since 2009, RADMP activities have contributed to reducing asthma-related emergency room visits by 94 percent and hospitalizations by 95 percent, equaling a total savings of more than $800,000. In addition, the average number of school days missed by children in the program decreased from 17 to nine, indicating an increased quality of life. Statistically significant improvements were made in clinical measures including lung spirometry and eosinophilic inflammation.
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Community in Action
Connecticut Children's Medical Center
In 1998, the city of Hartford, Connecticut had a growing population of low-income minority citizens with asthma. Only one-third of children with persistent asthma in this community were being treated with appropriate anti-inflammatory medication, and most of these children lived in old housing where pest infestation and overcrowding were common problems.
The community needed a cost effective asthma management program to assist busy primary care clinicians in diagnosing asthma and effectively treating patients. The result was the creation of the Easy Breathing© program.
Easy Breathing© — originally housed within the Connecticut Children's Medical Center — focuses on five elements of care: diagnosing asthma, determining asthma severity, prescribing therapy appropriate for the asthma severity, developing a written Asthma Treatment Plan that is understood by the family, and assessing asthma control.
Michelle M. Cloutier, MD, the Program Director of Easy Breathing at Connecticut Children's Medical Center.
The program then utilizes a database to track its outcomes, including environmental exposures, interventions and feedback for clinicians. The database is also used for research and reporting purposes, and it provides clinicians with information regarding the demographics of their patient population, environmental exposures and asthma severities for all children enrolled in the program.
An essential element of the program is the Easy Breathing© Survey, which is administered in the physician's office when the patient comes for an office visit. The survey helps parents identify environmental exposures in the home that are potentially problematic for a child with asthma. The results of the survey are then immediately discussed with the patient and are used as a starting point for education regarding avoidance and elimination of harmful environmental conditions, such as smoking in the home.
Today more than 106,000 children across the state have been enrolled in the Easy Breathing© program — more than 28,000 of which have asthma. This success is due in large part to extensive community partnerships between clinicians, parents, hospitals, clinics, schools, foundations, lung associations, housing authorities and pharmaceutical industry representatives that have been a cornerstone of the program from its inception.
Easy Breathing© has been tremendously successful and has lead to significant increases in the use of written treatment plans, decreases in hospitalization rates and emergency department visits for asthma, and increased usage of inhaled corticosteroids. The program is now being implemented throughout Connecticut and in nine other states.
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Michigan Department of Community Health
In the mid-90s, the Michigan Department of Community Health (MDCH) recognized asthma as a growing health problem, especially among low-income children and populations with economic, race and access disparities. As MDCH geared up to increase asthma awareness in these disproportionately affected communities, it quickly determined that a coordinated effort would ultimately have the greatest impact on health outcomes.
Therefore, in 2000, MDCH brought together more than 125 asthma experts to develop the first statewide plan to address asthma in communities bearing the highest burden. This successful collaboration lead to the creation of the Asthma Prevention and Control Program (APCP).
[Front row] l-r: Evelyn Gladney, Erika Garcia, Tisa Vorce, John Dowling [Back row] l-r: Bob Wahl, Judi Lyles, Sarah Lyon-Callo, Bill Baugh
The APCP, which provides expertise and long-term guidance for asthma quality improvement activities, has aided in the development and impact of many successful community-based asthma management programs across the state, such as Managing Asthma Through Case-management in Homes (MATCH). This program utilizes a combination of home, school and work visits; asthma action plans; and Medicaid reimbursement to provide long-term interventions and care for individuals with asthma. MATCH participants reported significantly fewer emergency room visits and hospitalizations, and had significantly shorter lengths of stay, if hospitalized due to asthma.
Recognizing the success of the program, APCP helped to replicate this model in other communities, and as a result, has more than doubled the number of people served by MATCH. Surveillance data and input from strategic partners have been key components to this success and are used to continuously measure both the state's and community's needs and to ensure that any changes in asthma burden result in adjusted programming.
Between 2000 and 2007, APCP's efforts have contributed to a 24 percent reduction in the asthma mortality rate in Michigan, preventing an estimated 182 deaths. Similarly, pediatric asthma hospitalization rates in the state decreased by 28 percent between 2000 and 2009. In addition, children enrolled in Michigan Medicaid programs exhibited a 41 percent decrease in asthma hospitalizations between 2005 and 2009.
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2011 Award Winners
Centene Corporation® Managed Health Services, Nurtur®
(St. Louis, Missouri and Indianapolis, Indiana)
As an experienced, comprehensive service provider, Managed Health Services, a Centene Corporation Medicaid health plan, understands the need to customize asthma solutions for diverse populations. As a result, in 2007 Managed Health Services and sister company, Nurtur, Centene life, a health and wellness company, established a comprehensive asthma program designed to address the needs of several specific target audiences; these include persons with asthma in addition to other complex chronic conditions, as well as pregnant women and children with asthma.
Pictured: Mike Flynn, Director, Office of Radiation and Indoor Air and Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, present Award to Patrick Rooney, Dr. Mary Mason and Dan Cave of Managed Health Services, Centene Corporation ® and Nurtur ®.
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Medical records, pharmacy records and claims data are scanned by predictive modeling software to identify patients that meet these criteria, who are then referred to the Asthma Team. A case manager follows up with each patient to assess their level of need and recommends an appropriate asthma intervention. Educational materials for children and adults, trigger identification training, goal-setting exercises, home visits and barrier assessments are just some of the many tools used as a part of this holistic asthma care process. The patient's treatment plan is also updated by the Asthma Team and sent to the physician for review. Continuous monitoring and evaluation are integral to this program, and results from 2007 to 2009 indicate an incredible 17.3 percent decrease in emergency department visits for child participants and a 9.4 percent decrease for adult participants. In addition, visits to primary physicians for children and adults were up by 11.1 percent and 16.4 percent, respectively, indicating improved preventive care.
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South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center
(Bronx, New York)
In New York's South Bronx community, one in five school-aged children has asthma — one of the highest rates in New York City. In response to this staggering statistic, Bronx-Lebanon Hospital Center's Department of Pediatrics created the Childhood Asthma Management Program in 2000. Through clinical pediatric asthma services, community-based activities of the New York State Department of Health-funded asthma coalition, and hospital-community collaborative programming, the program promotes asthma-friendly environments and ensures the delivery of integrated health care services for children with asthma.
Pictured: Mike Flynn, Director, Office of Radiation and Indoor Air and Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, present Award to Lauren Brown, Alexandra Meis, Dr. Mamta Reddy, Tomas Jimenez, Diane Strom and Evelyn Arguinzoni of the South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center.
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Early on, program staff members recognized that to improve asthma outcomes, they must not only improve provider knowledge and communication, but also strengthen the existing health system in which providers practice. As a result, the program conducts provider training sessions that translate asthma management recommendations into quality clinical practice to ensure that patients receive comprehensive asthma services across the care continuum. Furthermore, the program engages Medicaid to provide reimbursement incentives for provider participation in asthma education.
As the lead organization of the South Bronx Asthma Partnership, Bronx-Lebanon Hospital Center also partners with a variety of environmental agencies and community organizations to create tailored environmental interventions that address both indoor and outdoor asthma triggers. Program partners provide building walk-throughs, designate asthma-friendly zones at schools, and provide pest management assistance and air-sampling. In addition, the program distributes culturally appropriate and literacy-sensitive educational materials throughout the hospital and the community to promote patient self-management and encourage healthy behaviors in homes.
This multi-faceted approach to asthma care has resulted in tremendous success. Since 2003, Bronx-Lebanon Hospital Center has shown a 42 percent decrease in asthma-related hospitalizations, as well as a decrease in the length of stay of asthma-related hospitalizations. This equates to an annual average cost savings of about $431 per child. In addition, the National Asthma Control Initiative recently named the Bronx Lebanon partnership as a clinical champion in recognition of their efforts in promoting the Expert Panel Report 3 — Guidelines for the Diagnosis and Management of Asthma.
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New York State Department of Health, Center for Environmental Health, Healthy Neighborhoods Program
(Troy, New York)
In the early 1980s, the New York State Department of Health, Center for Environmental Health recognized that housing hazards were often complex and were best addressed by a neighborhood-level approach. As a result, the Center developed the Healthy Neighborhoods Program in 1985 — a statewide program aimed at improving housing conditions in high-risk communities through a holistic, healthy homes approach.
Pictured: Mike Flynn, Director, Office of Radiation and Indoor Air and Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, present Award to Amanda Reddy and Theresa McCabe of the New York State Department of Health, Center for Environmental Health, Healthy Neighborhoods Program.
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This program relies on an extensive network of grant-funded, local health department partners and emphasizes home environmental management as an enhancement to case management and clinical care. Local health departments initially identify target areas in the community for intervention and develop work plans to meet the specific needs of that area. These health departments are also encouraged to leverage local resources and infrastructure to ensure that the services delivered are meaningful and effective.
During home visits, field staff members assess a wide variety of healthy homes issues, including tobacco control, fire safety, lead poisoning prevention, indoor air quality, asthma control, injury prevention and more. Following the assessment, residents are provided with products, referrals and education to help remediate any potential hazards identified during the assessment. A quarter of homes receive a three-to-six month follow-up visit to reassess conditions. Any new or ongoing problems identified during the revisit are addressed.
This program has had incredible success for residents with asthma, with marked improvements in environmental triggers, including a 14% reduction in environmental tobacco smoke exposure and improved pest control in at least 44% of homes with pest problems. There have also been significant improvements in participants' knowledge about asthma triggers and significant decreases in the number of days with worsening asthma and in the number of work or school days missed due to asthma.
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2010 Winners
Community Asthma Initiative, Children's Hospital Boston
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Mike Flynn, Director, Office of Radiation and Indoor Air, U.S. EPA, present Award to (from left to right) Susan Sommer and Dr. Elizabeth Woods of the Community Asthma Initiative, Children's Hospital Boston
Children’s Hospital Boston developed the Community Asthma Initiative (CAI) in 2005 in response to alarmingly high rates of asthma among children living in Boston’s urban neighborhoods, especially underserved children and families. CAI is a patient-centered program that provides bilingual (Spanish) in-home family asthma education, environmental assessments and remediation; Integrated Pest Management; and coordination with primary care providers, in conjunction with community education, outreach and advocacy. Care is provided and coordinated through a culturally appropriate case management model that identifies barriers to good asthma control and includes home visits conducted by nurses and/or community health workers, depending on the family’s needs. To ensure it provides the services and information the community needs most, CAI convenes a Family Advisory Board. In response to the Family Advisory Board’s vision, CAI delivered an Asthma Community Forum, with over 100 attendees discussing asthma-related issues, including environmental management in homes and schools. CAI also offers educational programs and activities for community-based organizations, schools and provider groups. For example, CAI, along with the Boston Public Health Commission (BPHC), hosts the Boston Asthma Swim Program, which provides children with asthma the opportunity to engage in physical activities while learning about asthma control. To improve insurance coverage for case management and home visits — and to increase access to affordable medications and reimbursements — CAI works closely with the Office of Government Relations at Children’s Hospital Boston, BPHC and community partners, providing support for policy and system changes. The Initiative has achieved impressive results. For CAI patients, asthma-related emergency department visits have dropped by 65 percent and hospitalizations have decreased by 81 percent. Further, CAI calculated a
146 percent return on investment (ROI) to society due to lower hospital costs. Enrolled families have also reported a reduction in the limitation of physical activity (37 percent), asthma-related school absences (39 percent), and asthma-related work absences (49 percent).
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Neighborhood Health Plan of Massachusetts
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Mike Flynn, Director, Office of Radiation and Indoor Air, U.S. EPA, present Award to (from left to right) John Pruett, Joy Gonzalez, Dr. James Glauber and Cindy Cookson of the Neighborhood Health Plan of Massachusetts
Founded in the late 1980s, Neighborhood Health Plan (NHP) was one of the nation’s first health plans to comprehensively address the health care needs of underserved populations. As part of its commitment to improving the lives of its 200,000 members and in response to alarming rates of asthma among the Plan’s target population, NHP introduced its innovative Asthma Disease Management Program (ADMP) in 2000. NHP provides an Asthma Home Visitation Program (AHVP) to all members living with asthma in need of in-depth asthma education and/or home environmental assessment. NHP implemented an Enhanced Asthma Home Visit program in 2005 based on the positive outcomes of a one year Inner City Asthma Study (ICAS) of non-clinician home-based environmental intervention to reduce exposure to environmental triggers and allergens. The AHVP empowers patients to proactively manage their asthma by providing multilingual, low-literacy education to patients and their families during in-home environmental assessments and interventions. In addition, the ADMP helps primary care providers improve asthma care by enhancing programs at primary care sites; using a robust and comprehensive asthma registry; and increasing provider awareness and compliance with asthma treatment guidelines. To further address the appropriate management of asthma, NHP’s website provides access to several provider-focused resources. By collaborating with community-based initiatives, including the Boston Asthma Initiative, the Greater Brockton Asthma Coalition, and State and regional partners, the ADMP’s active leadership strengthens Massachusetts’ community-wide approach to asthma management. Over the past decade, the rates of annual asthma hospitalizations and emergency department visits for Neighborhood Health Plan’s asthma population have fallen by more than 30 percent.
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Sinai Urban Health Institute
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Mike Flynn, Director, Office of Radiation and Indoor Air, U.S. EPA, present Award to (from left to right) Gloria Seals, Helen Margellos-Anast and Melissa A. Gutierrez of the Sinai Urban Health Institute
Since 2000, the Sinai Urban Health Institute (SUHI) and Sinai Children’s Hospital (SCH) have partnered to reduce the burden of asthma on vulnerable Chicago communities. As many as one in four children living in the communities served by the Sinai Health System suffer from asthma, as revealed by the Sinai Improving Community Health Survey. Recognizing the disproportionate asthma burden faced by these communities, a series of four comprehensive asthma interventions have been conducted over the past 10 years. Each of these initiatives has focused on decreasing asthma-related morbidity and improving participants’ quality of life by utilizing Community Health Workers (CHW)—members of the community trained to deliver case-specific asthma education through home visits. With funding from the U.S. Centers for Disease Control and Prevention, SUHI and SCH initiated a comprehensive, multifaceted program in September 2008, called Healthy Home, Healthy Child: The Westside Children’s Asthma Partnership (HHHC). This unique program draws from the strengths of its collaborations with partner organizations and community members to address medical, social and environmental factors of asthma. At the heart of this program is the CHW, who provides one-on-one asthma education and environmental trigger reduction counseling to families in their homes. The CHWs also serve as a liaison between the family and medical system. Cost savings analyses and evaluations of these programs have enabled SUHI to demonstrate the approach’s value, proving that the program was a wise investment. Since the inception of the SUHI Pediatric Asthma Programs, there has been on average a 50 percent reduction in frequency of symptoms experienced by children (50.4 percent – 63.6 percent) and significant declines in asthma-related emergency department visits (47.6 percent – 73.5 percent) and hospitalizations (50.0 percent – 81.0 percent). In addition, the SUHI Pediatric Asthma Model has been replicated in other areas around Illinois.
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WIN for Asthma
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Mike Flynn, Director, Office of Radiation and Indoor Air, U.S. EPA, present Award to (from left to right) Robyn Scherer, Patricia Peretz and Dr. Luz Adriana Matiz of WIN for Asthma
In 2005, New York Presbyterian Hospital and community partners applied the principles of community based participatory research to develop the Washington Heights Inwood Network (WIN) for Asthma. This comprehensive program is designed to facilitate effective and sustainable asthma management in Northern Manhattan, a community with childhood asthma rates that are four times the national average. WIN is a multi-level, community-driven program that enhances case identification and follow-up for children. Through collaboration with key partners, including local day care centers, schools, clinics and community-based organizations, WIN provides community-wide asthma screening and education. Once families are enrolled in the program, bilingual community health workers offer family-focused asthma education, address household triggers, and link families to the clinical and social resources needed to facilitate effective and sustainable asthma management. By engaging and supporting local providers through the delivery of the evidence-based intervention, Physician Asthma Care Education (PACE), WIN works to ensure providers adhere to the latest asthma guidelines, resulting in improved quality of care. Through a partnership with the National Initiative for Children’s Healthcare Quality, WIN developed a comprehensive protocol for post-PACE provider support involving practice-based support. Through collaboration with multiple hospital divisions, the launch of a grassroots marketing campaign, and the development of a long-term business plan, WIN has worked to increase its visibility and successfully sustain its program. WIN’s program success is demonstrated in data collected from Community Health Workers (CHWs): Over a 3-year period, the number of asthma-related emergency department visits and hospitalizations decreased by more than 50 percent; caregivers’ confidence in controlling their children’s asthma increased by 40 percent; and asthma-related school absenteeism decreased by 30 percent.
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Woodhull Medical and Mental Health Center
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Mike Flynn, Director, Office of Radiation and Indoor Air, U.S. EPA, present Award to (from left to right) Dr. Edward Fishkin and Desire La Tempa of the Woodhull Medical and Mental Health Center
Twelve years ago, the Woodhull North Brooklyn Health Network implemented its comprehensive, evidence-based asthma management program to ensure best practices for asthma care were used to treat all asthma patients. By educating and training health care providers, community organizations and schools, Woodhull has taken a multi-faceted approach to improving asthma care in one of the nation’s highest-risk communities for asthma. At the center of this approach is the Network’s leadership in heading the North Brooklyn Asthma Action Alliance, a coalition that partners with national organizations, community groups and health care facilities to deliver a high standard of asthma care to the community. Supporting this work, the program trains doctors, nurses and hospital residents with its PACE program, which aligns with the National Institutes of Health Guidelines for Asthma Care, and utilizes a modified Electronic Health Record to ensure that all of Woodhull’s providers deliver Guidelines-based care. In partnership with Rutgers University, Woodhull performs ground-breaking education on environmental triggers to schools, including the distribution of checklists and diagrams outlining the process to eliminate common triggers. Woodhull also addresses patients’ home environments, distributing environmental control products such as allergen-proof pillow and mattress covers free of charge. Woodhull has renovated the emergency department with a state-of-the-art asthma treatment room, which offers patients assistance with their paperwork while they begin treatment. This fast-track approach has resulted in easier and more effective access to asthma treatment in emergency situations. The results of
Woodhull’s work are captured in its Asthma Registry: The number of visits to the pediatric asthma clinic more than doubled between 2008 and 2009, which correlated to a 58 percent reduction in asthma related emergency department visits and 67 percent decrease in hospitalizations.
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2009 Winners
Bethlehem Partnership for a Healthy Community – The Asthma Initiative
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Lisa Jackson, Administrator, U.S. EPA, present Award to (left to right) Mary Mittl, Susan Madeja and Elizabeth Roth of the Bethlehem Partnership for a Healthy Community — The Asthma Initiative
Based on the premise that strong patient-provider interaction is key to asthma management, the Bethlehem Partnership for a Healthy Community identifies and educates high-risk children and their families through the school system, improves access to preventive services and care, and provides up-to-date asthma education to the medical community. In partnership with St. Luke’s Hospital and the Bethlehem Area School District, the initiative helps to manage asthma through multiple access points: school-based health clinics, Open Airways Programs, mobile school health clinics, and St. Luke’s Hospital Clinic. The program educates and supports clinical care teams by providing annual education and training to health care providers and coalition partners. Patient education includes multiple, bilingual home visits and thorough patient follow-up. Working with the Bethlehem Health Bureau, the initiative evaluates homes for environmental triggers while distributing trigger-reducing items (such as mattress covers and green cleaning supplies), provides one-on-one education to families, and assists tenants in contacting landlords in order to correct mold and cockroach issues. Through a successful partnership with Lehigh University, the program expanded to address outdoor air quality during the home visit survey. The initiative has proven to be effective: From 2007-2008, multiple asthma-related pediatric emergency department visits for individual patients decreased by 56 percent.
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Boston Medical Center/Boston Public Health Commission
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Lisa Jackson, Administrator, U.S. EPA, present Award to (from left to right) Margaret Reid and Dr. Megan Sandel of the Boston Medical Center Boston Public Health Commission
Staffed by pulmonologists, allergists, public health staff, and an extensive translation services program—with over 30 languages spoken—Boston Medical Center’s (BMC) collaboration with the Boston Public Health Commission (BPHC) provides excellent clinical and environmental care and promotes improved asthma self-management for the city’s underserved populations. The program educates patients about asthma management and environmental triggers, facilitates access to needed services (medical legal partnership, housing, and insurance), and promotes strong provider-patient relationships that contribute to improved patient outcomes. BMC’s environmental focus includes partnerships with several Boston agencies to launch the Breathe Easy at Home Program, a Web-facilitated program that gives health professionals a way to report potential housing code violations that may worsen patient asthma, and the Boston Inspectional Services Department responds to reports by working with property owners to remediate the situation. In striving to offer effective and accessible primary care and outpatient services, BMC successfully works with their most utilized health plans to provide asthma education and case management services and provides exceptional care without exception. The city of Boston is reaping the benefits of this powerful collaboration. The hospitalization rate for Boston’s children with asthma has decreased 39 percent and emergency department visits are 16 percent lower.
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California Department of Public Health/Center for Chronic Disease Prevention and Health Promotion
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Lisa Jackson, Administrator, U.S. EPA, present Award to (from left to right) Dr. David Nunez, Sara Campbell-Hicks and Dr. Rick Kreutzer of the California Department of Public Health – Center for Chronic Disease Prevention and Health Promotion
Serving nearly 38 million people, the California Department of Public Health - Center for Chronic Disease Prevention and Health Promotion provides multi-faceted asthma management and care to children and adults through programs based in schools, workplaces, and the community at large. The Work-Related Asthma Prevention Program provides customized educational materials to underserved adults with workplace-related asthma, analyzes data to identify high-risk industries and appropriate interventions, and conducts site investigations. The California Breathing Program conducts school-based programs that emphasize environmental interventions, train staff and childcare providers, and offer incentive-based awards to schools that create healthy environments. Community-based grants to local organizations fund a range of interventions including technical assistance on topics such as pest management in housing developments, second-hand smoke reduction, and mold intrusion training for code enforcers. Environmental interventions are complemented by the California Asthma Public Health Initiative where clinicians assess individual allergen sensitivities, educate families, and often provide free products to reduce exposure to triggers. In participating clinics, the number of children with written asthma action plans increased 84 percent, and asthma-related emergency department visits dropped by 78 percent.
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Genesee County Asthma Network
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Lisa Jackson, Administrator, U.S. EPA, present Award to (from left to right) Pauline Sidiropoulos MSW, Michelle Cox RRT, Jan Roberts RN, Joni Zyber RN, and Lori McQuillan CHES of the Genesee County Asthma Network
Focused on inner-city children in the Flint, Michigan area, the Genesee County Asthma Network (GCAN) is a comprehensive community-based program that delivers high quality asthma care through asthma and allergy specialists, physicians, and two registered nurses who are certified asthma educators. The asthma educators complete up to 200 home assessments each year where they identify asthma triggers, while an accompanying social worker identifies potential barriers to successful asthma management such as financial hardship, transportation, or family issues. Incentives and awards motivate patients and families to follow through with self-management advice. Classroom assessments (that identify and encourage schools to fix environmental problems) often complement home inspections and ensure that patients are well prepared to address their environmental asthma triggers. Asthma educators accompany patients on clinical visits to review medications and help develop a personalized asthma action plan. With the support of Hurley Medical Center and working with numerous partners in the community— including the American Lung Association, faith-based organizations, health providers and payers, and Habitat for Humanity, which built an asthma-friendly home for one patient’s family—GCAN has produced dramatic results. Asthma-related emergency department visits have dropped by 45 percent; hospitalizations by 25 percent.
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Seton Asthma Center
Gina McCarthy, Assistant Administrator, Office of Air and Radiation, U.S. EPA, and Lisa Jackson, Administrator, U.S. EPA, present Award to (from left to right) June Niblett, Steve Conti and Kenna Griffith of the Seton Asthma Center
The Seton Family of Hospitals formed the Seton Asthma Center in 2004 to respond to a rise in asthma-related pediatric emergency department visits and hospitalizations, especially among economically disadvantaged and underserved populations. The Center’s case management workers, all registered respiratory therapists, promote improved patient self-management in bilingual patient education sessions that include in-home environmental assessments, training on appropriate use of medications and peak flow meters, and the development of personalized asthma action plans. The asthma action plan serves as a communication tool between the primary care provider, the school nurse, and the patient. The case managers review each asthma action plan quarterly to ensure each patient has a current, effective plan in place. The Center also operates a mobile caravan that makes monthly visits to public schools to deliver asthma care to uninsured and indigent students. Case managers have partnered with the Central Texas Asthma Coalition and the American Lung Association’s Lung Health Initiatives Committee to raise public awareness, educate providers, and collect surveillance data. This partnership has led to the use of a standardized set of metrics to assess the burden of asthma in the community. For patients enrolled in the program, asthma-related emergency department visits have dropped by 75 percent, and the number of in-patient visits has decreased by 85 percent.
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2008 Winners
The Asthma Network of West Michigan (ANWM)
Elizabeth Cotsworth, Director, Office of Radiation and Indoor Air, U.S. EPA, and Beth Craig, Deputy Assistant Administrator, Office of Air and Radiation, EPA, and Chris Draft, NFL player, present Award to (from left to right) Karen Meyerson, Mark Huizenga and Lil De Laat of the Asthma Network of West Michigan (ANWM)
The Asthma Network of West Michigan (ANWM) is a community coalition that provides comprehensive home-based case management to 94,500 children and adults with asthma in West Michigan. ANWM has demonstrated impressive results including improved health outcomes and cost savings. This success has led to a partnership with Priority Health (a winner of the 2007 National Environmental Leadership Award in Asthma Management) who agreed to reimburse ANWM for its home visit program. This partnership with Priority Health is the nation’s first agreement between a grassroots coalition and a managed care plan. ANWM now has contracts with five local health plans and its asthma management program provides asthma education, coordination with health care providers, development of asthma action plans, home environmental assessments, and social service support. ANWM’s comprehensive care costs $2,500 per person annually and has led to a 64 percent decrease in hospitalizations and a 60 percent decrease in ER visits. These improved health outcomes resulted in approximately $800 in net health care cost savings per child per year.
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The Monroe Plan for Medical Care
Elizabeth Cotsworth, Director, Office of Radiation and Indoor Air, U.S. EPA, and Beth Craig, Deputy Assistant Administrator, Office of Air and Radiation, EPA, and Chris Draft, NFL player, present Award to (from left to right) Dr. Joe Stankaitis and Deborah Peartree of the Monroe Plan for Medical Care
The Monroe Plan for Medical Care is a managed care organization, located in the Rochester, New York area. The Monroe Plan covers 5,633 children with asthma in Monroe County and 12 neighboring rural counties. With a high asthma burden among children in the area, the Monroe Plan saw trends in pediatric asthma and noticed high admission rates that disproportionately affected minorities. In partnership with ViaHealth, a health care delivery system, the Monroe Plan launched a program to shift asthma care away from emergency services and inpatient care and toward improved patient self-management. The program now covers all of the plan’s members with moderate to severe pediatric asthma and includes assistance to providers in creating asthma action plans and comprehensive provider and member education. Home assessments are conducted by bilingual asthma outreach workers to identify and reduce environmental triggers. As a result of these interventions, ER visits decreased from 1.1 visits per person to .95 visits per person over the first three years of the program. Inpatient admissions decreased from 98.3 admissions per thousand to 84.15 per thousand in the first three years of the program.
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The University of Michigan Health System Asthma Quality Improvement Steering Committee
Elizabeth Cotsworth, Director, Office of Radiation and Indoor Air, U.S. EPA, and Beth Craig, Deputy Assistant Administrator, Office of Air and Radiation, EPA, and Chris Draft, NFL player, present Award to (from left to right) Karla Grossman, Dr. Annie Sy, Dr. Steven Bernstein, DeAnn Vansickle, and Dr. Georgiana Sanders, of the University of Michigan health System (UMHS)
The University of Michigan Health System (UMHS) is a non-profit health care provider serving 12,214 adults and children with asthma in four counties in Southeastern Michigan. Since 1997, the UMHS Quality Improvement Steering Committee, a group of multidisciplinary volunteers, has guided improvements in asthma care across the health system. The UMHS Asthma Management Program includes specific, population-based programs for high-risk asthma populations and in-home asthma education through the Michigan Visiting Nurses Asthma Home Environmental Assessment Program. Web-based, standardized NHLBI-compatible guidelines are available to all providers, including standardized Asthma Action Plans and education templates. A comprehensive, validated, all-payer database of asthma patients helps UMHS identify areas of need for targeting interventions and assessing outcomes. As a result of these programs, UMHS achieved a 50 percent decrease in asthma-related hospitalizations from July 2005 to June 2007. Between June 2006 and June 2007, participants in the home assessment program had a 60 percent decline in ED visits and an 85 percent decrease in hospitalizations.
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Priority Health, Grand Rapids, Michigan
Priority Health is a non-profit health plan that serves more than 19,000 people asthma in 43 Michigan counties. In the late 1990s, Priority Health recognized the need for home-based asthma care that includes environmental trigger management. To deliver effective home-based care, Priority Health formed a first-of-its-kind partnership with the Asthma Network of West Michigan (ANWM). Priority Health uses ANWM’s case managers and social workers to increase its ability to effectively assess and educate its members. ANWM provides home-based education; home environmental assessments; and resources to reduce exposures to environmental asthma triggers.
From Left: Ruth Kavanagh, Elizabeth Cotsworth, Mary Cooley
Today, all of the plan’s members with moderate or high risk asthma within ANWM’s service area receive intensive case management that integrates patient education, home-based environmental interventions, and evidence-based clinical care. Priority Health also reimburses ANWM for meeting with providers to develop individualized care plans. These plans are the cornerstone for determining appropriate interventions, monitoring, and follow-up. Priority Health provides incentives to their providers to ensure that members use asthma medications appropriately and to implement the Planned Care Model for asthma. The results of these programs include improved medication use and significant reduction in the number of emergency room visits and hospitalizations for asthma. Utilization data show that emergency room visits were reduced from 72 visits per thousand patients in 2002 to 40 in 2006 for commercial members, and from 250 to 189 for Medicaid members. Savings over time for members are estimated at $1.7 million, and the long-term return on investment (ROI) for Priority Health is 2.1:1.
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MaineHealth AH! Program, Portland, Maine
MaineHealth's service area covers 90,675 patients with asthma, including 27,156 children in southern, central, and western Maine. The AH! (Asthma Health) Program combines standards-based clinical care in the patients’ communities with robust indoor and outdoor environmental asthma management. Patients receive in-depth counseling to manage exposures to environmental triggers in home, school, and work settings. Educational materials are culturally appropriate, translated into six languages, and use pictograms for low literacy populations. The Program supports wide dissemination of information on outdoor asthma triggers including ozone and particulate matter. The AH! Program has a strong presence outside its clinical settings, having built long-term relationships with community organizations, schools and daycare centers, public health departments, and others. The AH! Program also takes leadership positions to advocate for municipal, state, or national public policy actions -- such as bans on tobacco use in public places -- that create asthma-friendly environments.
From Left: Donna Levi, Julie Osgood, Elizabeth Cotsworth, Rhonda Vosmus
The AH! Program is strongly committed to providing integrated health care; they have created advisory committees that provide regular communication and coordination with primary and specialty care physicians, asthma educators, care managers, home health nurses, and others in the community interested in asthma care outcomes. The results of these impressive efforts have reduced emergency room use, hospitalizations, and missed school and work days, and improved physician adherence with national guidelines for asthma care. Evaluations at six months post-intervention show a 61 percent reduction in appropriate emergency room use and a 29 percent reduction in hospitalizations. Research over the past nine years shows that the improvements at six months are largely sustained. Maine Medical Center, one of MaineHealth’s member hospitals, achieved a reduction in emergency room visits from 81 percent to 20 percent and hospitalizations from 32 percent to 3 percent. These improved outcomes resulted in 2006 avoided costs of $61,635 on emergency room visits and $411,470 on hospitalizations.
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Blue Cross of California, State Sponsored Business Unit
Blue Cross of California, State Sponsored Business Unit (SSB), has designed a Comprehensive Asthma Intervention Program (CAIP) to improve care for California Medi-Cal
and Healthy Families members with asthma. Because standard asthma management programs seldom address the needs of all members in a culturally and linguistically diverse,
low-income population, like the Blue Cross SSB membership, who often face environmental health challenges, CAIP encompasses innovative partnerships with members, providers,
academic institutions, public health organizations, and communities, to maximize opportunities for improved asthma outcomes.
Elizabeth Cotsworth, Director, Office of Radiation and Indoor Air, U.S. EPA, presents Award to the Blue Cross of California, State Sponsored Business Unit
CAIP includes individual member outreach;
resources and incentives for physicians and pharmacists to encourage improved asthma care; Plan/Practice Improvement Project (PPIP), a collaboration modeled after the
Institute for Healthcare Improvement’s Breakthrough Series, to enhance asthma chronic care through practice-specific redesign; Valley Air Quality Project, a
county-specific partnership to improve community responses to environmental air pollution affecting the respiratory health of Fresno County, where asthma prevalence
is high.
"I’m extremely honored by our award from the EPA and proud of our growing partnership with them. The EPA is one of the premier organizations in our country that is fighting for higher standards for clean air, a cause that SSB celebrates. SSB looks forward to an ongoing relationship that is rooted in our common goal to create a healthier world for our members and their communities."
John Monahan, President of Blue Cross of California State Sponsored Business (SSB).
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IMPACT DC
(from left to right) Abisola Ayodeji, Beth Dunbar, Jordan Schmidt, Dr. Radha Chirumamilla, Alicia Newcomer, Deborah Quint, Dr. Stephen Teach, and Terry Ahern of IMPACT DC
Improving Pediatric Asthma Care in the District of
Columbia (IMPACT DC) Asthma Clinic targets inner-city, minority and disadvantaged children who suffer disproportionate asthma morbidity and mortality. Most live with challenging social and
environmental circumstances with daily exposure to multiple asthma triggers. Their families often have a tenuous connection with their primary care providers, and thus frequently rely on emergency departments (EDs) for asthma care. While EDs typically provide excellent episodic care for acute asthma exacerbations,
they usually pay little attention to longitudinal management issues. As a result, many families view asthma as an episodic problem instead of a chronic disease
requiring daily management. IMPACT DC’s fully validated program recruits from a large urban ED (Children’s National Medical Center) and focuses on
three distinct domains: environmental control, medical management, and longitudinal care. In a prospective clinical trial, it improved multiple patient outcomes.
It is an innovative, replicable, and cost-efficient national model for asthma mitigation among children in the inner city.
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Read about the 2005 winners in the article, “Recognizing the Environmental Role in Asthma Management Programs,” that appeared in AHIP Coverage, a magazine published by America’s Health Insurance Plans (Kral K and Belmont K. "Recognizing the environmental role in asthma management programs."
AHIP Coverage 
. 2005 Sept-Oct: 52-59.)
Optima Health
Elizabeth Cotsworth, Director, Office of Radiation and Indoor Air, U.S. EPA, presents Award to Optima Health
The staff at Optima Health Plan – the managed care division of
Sentara Health Care that operates in southeastern Virginia – noticed a disturbing trend: despite pharmacological advances in asthma therapy, the number of
emergency room visits, hospitalization rates, and medical costs for asthma patients continued to rise. The quality of life for the approximately 8,500 asthma
patients enrolled in Optima’s plan was not as high as Optima’s staff thought it should be and staff was committed to helping their asthma patients
understand everything they could do to prevent asthma attacks. Optima’s staff also knew that education and management advice were often most effective
when delivered at home so they developed an innovative “Asthma Life Coach” program that sends nurses and respiratory therapists to asthma patients’
homes where they work with patients and their caregivers to identify environmental triggers, such as secondhand smoke, cockroaches, dust mites, mold, and other sources
that can trigger asthma attacks. Optima’s staff understood that many asthma patients simply don’t know that things in their homes, schools, and other
environments can trigger asthma attacks and that many asthma triggers can be eliminated through simple management techniques. The Asthma Life Coach program provided
an easy way for Optima’s asthma patients to learn about environmental asthma triggers and how to reduce exposure to them. Optima’s staff visited patients
at home where they surveyed their environments, reviewed their use of medicines, and developed individualized written asthma treatment plans incorporating medical and
environmental components. Optima’s Asthma Life Coaches serve as coordinators helping patients take action based on disease management suggestions and physician
recommendations and ensuring that patients know how to use medical and environmental controls to manage their asthma. Since instituting the Asthma Life Coach program
in 1999, Optima has seen a significant decrease in the number of hospitalizations and emergency room visits for their members with asthma.
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Children's Mercy Hospitals and Clinics
Jeff Holmstead, Assistant Administrator, Office of Air and Radiation, EPA, presents Award to the Children's Mercy Hospitals and Clinics
Children’s Mercy Hospitals and Clinics — serving families in Nebraska, Oklahoma, Kansas, and Missouri — uses a creative approach for managing pediatric asthma. Children’s
Mercy trained a team of asthma educators to implement a three-part environmental asthma management program that included education for providers and staff;
personalized case management and education for families with high hospital utilization due to asthma; and in-home, school, and day care environmental assessments
to determine the presence of asthma triggers. Children’s Mercy determined that for those patients with severe cases of asthma, home-based, hands-on
education about the common environmental asthma triggers was critical to ensuring that patients gained control over their asthma and made the connection between
their asthma symptoms and environmental triggers in their home environment. During the home assessments, Children’s Mercy staff conducts a comprehensive
environmental and safety assessment that identifies common environmental asthma triggers. Based on the home assessments, asthma educators provide personalized
environmental health action plans to help patients and their families identify their asthma triggers and to reduce these triggers in their home. Through a creative
partnership with the Healthy Homes Network for Kansas City, and funded by a HUD Healthy Homes Demonstration grant, qualifying families are provided up to $2,000 worth
of home supplies and repairs to try to reduce environmental asthma triggers. As a result of Children’s Mercy’s efforts, patients and their families know
more about what triggers their asthma and how to control asthma symptoms. Children’s Mercy has seen fewer emergency department visits and hospitalizations since
the program’s inception.
"We were very honored to win this award on behalf of Children’s Mercy Hospital and Family Health Partners. Receiving this award empowered us to
continue the great work we were doing and take it to the next level. Our health plan received an additional state contract because of our success and award
winning management of asthma and indoor environments.
Our goal is to take what we learned from our hard work on effective asthma management with families and apply this knowledge to building effective
asthma management for the entire community. The more we can improve awareness education in our community, the healthier our community will be for all
children."
Kevin Kennedy, Program Manager, Environmental Health Program,
Children’s Mercy Hospitals and Clinics
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2005 Honorable Mentions
Neighborhood Health Plan of Rhode Island
Founded in 1993, Neighborhood Health Plan of Rhode Island (NHPRI) is the leading provider of health insurance to low income and minority children and families in
the state, serving nearly 75,000 Medicaid members. NHPRI’s asthma program has one simple goal: to enable members with persistent asthma to live normal, healthy
lives. To achieve their goal, NHPRI developed a multi-faceted education and outreach program to address environmental management of asthma, with educational modules
tailored to the needs of providers, asthma patients and their families. NHPRI gave providers clinical practice guidelines; continuing medical education credits for
learning about environmental asthma management; and incentives for referring patients to the home visit component of NHPRI’s asthma management program. NHPRI
also offers a range of services for patients. The services vary depending on the patient’s asthma severity. Patients diagnosed with severe persistent asthma and
who have been hospitalized or visited an emergency room automatically receive an initial call or home visit from an Asthma Case Manager and ongoing interactions to
educate the patient and family about comprehensive asthma management. NHPRI developed a more specialized home visit program called “Beating Asthma,” for
patients with persistent asthma living within three high-need communities. To reach those patients, NHPRI trained bilingual and bicultural Asthma Advocates to conduct
home visits that combine education about medical management with an assessment of environmental asthma triggers found in the home and information on controlling them.
Patients and families that participate in the “Beating Asthma” program, receive a calling card, peak flow meter, a written, personalized Asthma Action
Plan, allergy-free mattress and pillow covers, and a supermarket gift card. NHPRI’s preliminary results indicate that participants in the “Beating
Asthma” program have experienced a reduction in emergency department visits, use of rescue medications, and unscheduled outpatient visits. NHPRI’s
approach targets healthcare providers and asthma patients to ensure that each group receives the information it most needs to reduce the burden of asthma for
Rhode Island families.
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Connecticut Children’s Medical Center Easy Breathing Community Initiative
The Easy Breathing Program improved asthma care by educating primary care clinicians about disease management standards and the importance of environmental asthma management. The program was
launched in 1998 to serve a poor, urban community in Connecticut where approximately 85% of the children served were Medicaid and SCHIP-eligible. The Easy Breathing Program has
been so successful and well-documented that, over time, it has been replicated by healthcare providers and clinics throughout Connecticut and across the country. Easy Breathing focuses on
training healthcare providers in the appropriate use of pharmacologic therapies, environmental management, and culturally appropriate patient outreach. Providers receive asthma management
education in phases – starting with guidance on recognizing asthma, followed by tips on successfully managing it. As providers moved through the phases of learning, they requested additional
information and outreach materials that they could use with their patients. Easy Breathing provided culturally appropriate materials for providers to use to educate patients from all backgrounds and language
communities. Easy Breathing coached providers on identifying a patient’s asthma severity, skin testing patients to identify allergens that trigger each patient’s asthma, and developing
personalized asthma treatment plans with patients and their caretakers that include guides on using appropriate medications and following environmental asthma management techniques. In
collaboration with the Hartford Pediatric Asthma Coalition, Easy Breathing developed a standardized home environmental assessment tool to survey home environments and make
recommendations to families living with asthma on how to reduce environmental asthma triggers. To date, over 55,000 children in Connecticut have been enrolled in Easy Breathing and
participants have shown a significant decline in hospitalizations, emergency department visits, and an increase in the appropriate use of medications.
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