For children, chronic asthma is more than just a healthcare concern; struggling to breathe leads kids to miss school days, which impacts their education and, potentially, their ability to work and succeed in life.
There is a growing understanding that controlling the disease requires not just medical treatment, but also addressing environmental factors like the dust, pollen, and chemical residue often found in homes, schools, and other places frequented by children.
In an effort to improve health and social outcomes related to asthma — and reduce treatment costs — the New Jersey Department of Health has partnered with The Nicholson Foundation to launch a pilot project designed to reduce disease triggers in the homes of hundreds of children who are struggling to control the condition. Participants said the goal is to create an effective model that could be expanded statewide, or beyond.
The two-year program is based on models that have been effective elsewhere; it involves identifying children suffering with chronic, uncontrolled asthma and dispatching trained community health workers to assess their home, educate caregivers on how to reduce irritants, and provide mattress covers, cleaning products and other supplies. It will focus on kids age two to 17 in NJFamilyCare, the state’s Medicaid program.
“Asthma can be managed by avoiding environmental triggers and properly using medications,” said Cathleen Bennett, former DOH commissioner, who has since left to head the New Jersey Hospital Association; on Thursday Gov. Chris Christie announced Christopher Rinn, who has served as an assistant commissioner of public health infrastructure, would serve as acting commissioner.
“By integrating asthma in-home interventions with clinical care, this population health approach will give children and their families a chance to breathe easier and live healthier lives,” said Bennett, who prioritized public health during her tenure at DOH.
Announced last week, the pilot program is the latest in a growing number of healthcare efforts that seek to go beyond the hospital or doctor’s office to provide care — or sustain wellness — in homes, workplaces, and communities. The trend reflects, in part, a new focus on the “social determinants of health” —factors like poverty, pollution, and insecurity about food and finances — that play a significant role in the health of an individual and their community.
Studies have shown how ZIP codes influence health and life expectancy, including an analysis by researchers at Virginia Commonwealth University that revealed a 14-year difference between the lifespan of residents in Trenton and those who lived in Princeton Junction, not far to the north. A collaboration of healthcare providers, community organizations, and city officials has addressed some of the key factors, including an asthma-intervention and remediation program run by the nonprofit group Isles Inc.
So far, the results from these asthma-intervention efforts appear promising. Jersey City Medical Center, which has run a similar program that has helped some 500 Hudson County children since 2012, found that these youngsters missed less school and were far less likely to be woken up at night by breathing problems. Absenteeism dropped from nearly 40 percent to close to 20 percent among this group, officials said, and overnight asthma attacks declined from nearly 40 percent to just over 11 percent.
“Absenteeism is a big issue when it comes to asthma,” explained Sharnia Williams, the population health coordinator at JCMC, which is part of the RWJ/Barnabas Health system. “We’ve definitely made a difference to a lot of people,” she added.
According to the health department, nearly 174,000 children, on estimate, are living with asthma in the Garden State. When triggered, it causes inflammation of the airways and lungs that can lead to coughing, wheezing, shortness of breath and, in the worst case, death. Studies show the condition is also one of a number exacerbated by heat, increased pollen and pollution, and other factors associated with climate change.
For many, the disease – which cannot be cured – is easily controlled with medications and careful monitoring. But in 2015, state data shows more than 1,500 children under age five were hospitalized for asthma attacks and 116 children, among all age groups, died of the disease. Like a number of medical conditions, rates are significantly higher among black and Hispanic children and among those from low-income families.
“Asthma is a chronic disease, with attacks most commonly triggered by environmental factors. Controlling those factors will lead to improved overall health and wellbeing, require less frequent hospitalizations, cut school absenteeism, and reduce healthcare costs,” said Arturo Brito, a pediatrician and executive director of The Nicholson Foundation. “Asthma is a very manageable disease, and it is unacceptable for anyone to be dying of asthma in 2017.”
Treating asthma at home
The New Jersey Asthma In-Home Intervention Pilot Project will involve community healthcare providers based in Paterson, Trenton, and parts of Monmouth County, with expertise and other support provided by Rutgers University and the pediatrics department at University Hospital in Newark. Over the two-year period, it is expected to reach nearly 500 families, while also providing new skills to community health workers.
Raquel Mazon Jeffers, a senior program officer at Nicholson, said it represents a true investment in public health. The foundation’s $1 million grant, which Jeffers oversees, will pay for a health worker to make three home visits to each family, and check in six months later — work that cannot be paid for through the Medicaid program.
Children with asthma should ideally receive appropriate inhalers or other medicine from their pediatrician along with a detailed “asthma action plan” that outlines specific steps to avoid attacks, Jeffers said. But in some cases, that youngster is then going home to a house with dust, smoke, or roach infestation, which also aggravates the condition.
“You can have the best medical care, but if there are triggers at home it’s still going to be exacerbated,” she explained.
The program will allow these health workers to review medications, help families better understand how to manage the disease, and address specific triggers in the home. “It’s shown to have demonstrable results,” Jeffers added. “Our goal is to really prove the concept so all kids can have access to this kind of service.”
A key part of the program is ensuring community health workers can effectively educate the families involved, experts said. The job involves discussing sensitive subjects — housecleaning habits, personal behaviors like smoking, proper pet care — without appearing condescending.
“We always want to remind our members we are here to educate them — that we’re here to help them and this is a free resource,” explained Williams, with JCMC. “It does take a while to build a trusting relationship,” she added, “but once we have that connection with the patient, everything else is easy.”