Washington Heights/Inwood Network for Asthma

Based in Washington Heights/Inwood and West Harlem, the project area extends from 130^th Street to the northern tip of Manhattan and from the Hudson River to Saint Nicholas Avenue (roughly six square miles)

• As of 2000, one-fourth of West Harlem and 66% of Washington Heights/Inwood residents were foreign born, primarily Dominican, Haitian and West African 
• In 2004-2005, surveys  found that one fourth of the children in the area had asthma- 4x the national average.  Of those children with asthma, 40% in Washington Heights and 47% in Harlem had persistent symptoms, 11% in Washington Heights and 17% in Harlem made an asthma-related visit to the emergency department within the past year.surveys found that a fourth of the children in this area had asthma- 4x the national average

At the end of the four year grant, WIN for Asthma expects the following outcomes:

• decrease in the rate of hospitalizations, emergency department visits, and schools absences by 25% for the entire Northern Manhattan community;
• decrease in the rate of hospitalizations, emergency department visits, and schools absences by 33% for children participating in WIN for Asthma program;
• decrease in the rate of hospitalizations, emergency department visits, and schools absences by 50% for children participating in WIN for Asthma's Care Coordination program 

Objective 1: Comprehensive care coordination for high risk children with asthma

• Identify high risk children with asthma through community provider practices, Pediatric emergency department at MS-CHONY, MS-CHONY General Pediatrics wards and Pediatric Intensive Care Unit, CBO partners, partner schools and day care centers
• Implement asthma screening (using modified NCICAS asthma prevalence survey) at day care centers and schools to identify high risk children for care coordination services
• Family Asthma Workers implement NCICAS (trigger assessment/reduction, medication adherence, education) in home visits for children and establish asthma management goals with the family

Sample process measures:Of families in Care Coordination: 50% accept home visits, 15% receive Integrated Pest Management services, 100% of families take steps to make their home asthma-friendly.
Sample outcome measures: For children enrolled in Care Coordination: 50% reduction in hospitalizations, 50% reduction in Emergency room visits, and 50% reduction in absences.

Objective 2: Improved effectiveness of medical care offered to children with asthma in Washington Heights/Inwood

• Partner with pediatric providers in the Northern Manhattan area and provide mentoring and supportive services to improve asthma care using an enhanced Physician Asthma Care Education (PACE) model
• Provide CME credit to participating physicians,  CNE credit to participating nurses and invite other healthcare providers to participate in PACE training.
• Develop individualized plan with each practice/providers to target Quality Improvement initiatives around asthma management and work with practices on sustaining changes implemented

Sample process measures:50% practices successfully complete 2 PDSA cycles
Sample outcome measures: 75% of practices report satisfaction with PDSA process, 75% of practices report improvement in asthma management with at least 1 asthma quality of care indicator

Objective 3: Improved asthma education for parents and children

• Through care coordination, implement asthma education for children and families in the home using modified NCICAS materials
• In collaboration with the Department of Health, school nurses deliver Open Airways for Schools
• Program staff conduct regular asthma education workshops in CBOs, provider practices, school settings.

Sample process measures:# of participants attending asthma education workshops; # of workshops held annually
Sample outcome measures: % of families who report improved confidence in managing child's asthma

Objective 4: Facilitate Asthma-Safe Environments

• Collaborate with Asthma Free School Zone to target environmental issues around schools, such as smoking and bus idling     
• Refer care coordination families with smokers to smoking cessation programs
• Work with Healthy Schools Healthy Families (HSHF) to implement at least one trigger reduction activity in each HSHF school

Sample process measures:% of schools implementing trigger reduction activities; % of referred caregivers participating in tobacco cessation activities 

A Dominican mother of two asthmatic children was referred to the WIN for Asthma Program through a school screener that she filled out on behalf of her 10 year old child who attends PS 128.  At the time of referral, the mom reported that between her two children she had been to the ED and urgent care four times within the past 6 months.   After learning more about asthma management, and environmental triggers through WIN for Asthma, the mother reported at the 6 month follow-up meeting that both children were asymptomatic for more than five months and that they are taking controller medications daily.