Collaboration Between Health Care and Public Health Workshop Summary (2016) / Chapter Skim
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5 A Collaborative Community Approach to Asthma Care
5 A Collaborative Community Approach to Asthma Care
Pages 49-62
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From page 49... ...
. Allan noted that work on asthma control has its roots in the successful experience with lead hazard control, where medicine and public health have a long-standing relationship around case identification and referral processes leading to interventions that reduce exposures.
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From page 50... ...
These successful collaborations also build respect and trust, which open the door for broader initiatives and powerful population health alliances. In this session, Shari Nethersole, executive director for community health at Boston Children's Hospital and assistant professor of pediatrics at Harvard Medical School, and Margaret Reid, director of the Division of Healthy Homes and Community Supports at the Boston Public Health Commission, discussed a collaborative approach to asthma care in Boston as a case example of a successful health care–public health collaboration.
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From page 51... ...
Care coordination is provided by bilingual and bicultural community health workers and nurses during home visits. These caregivers work with the family to establish goals for asthma control and identify barriers to good asthma control.
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From page 52... ...
The Community Asthma Initiative has also developed a program replication manual to guide others in starting an asthma home visiting and case management program, including advice on partnerships and monitoring and evaluation.5 The initiative is looking at how to move the model upstream, from identifying children through emergency room visits and hospitalizations as the index point to identifying them in the primary care setting. The 4 "There was a significant reduction in hospital costs compared with the comparison community (P <.0001)
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From page 53... ...
The payment will not cover the cost of the service the Community Asthma Initiative is providing, she noted, but it is the beginning of developing a new payment model. BOSTON ASTHMA HOME VISIT COLLABORATIVE The Boston Public Health Commission has conducted asthma home visits for a long time, Reid said.
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From page 54... ...
There are monthly meetings of community health workers who perform asthma home visits. A nurse, nurse practitioner, or physician attend every meeting to provide clinical oversight, along with a facilitator from the Public Health Commission.
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From page 55... ...
To expand reimbursement, insurers wanted standardized training of community health workers, standardized skills assessment and evaluation, and an easy referral system. As noted above, the Boston Public Health Commission has been selected to oversee the training of community health workers for the state, including a mentorship or practicum phase, and is looking to partner with other asthma home visiting programs to provide mentorship.
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From page 56... ...
Boston, like many communities, has small homeowner grants and loans that can help small property owners to maintain decent housing and offers technical assistance on such issues as integrated pest management. The City of Boston is now conducting proactive inspections for code violations (i.e., without referrals)
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From page 57... ...
Mary Pittman from the Public Health Institute asked whether there have been challenges from other provider groups over potential conflicts in scope of practice. Reid said that in the Boston Public Health Commission, the community health workers are in union positions, and the state of Massachusetts is working on a credentialing system.
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From page 58... ...
Nethersole said that they are working to understand what the care coordinators, patient navigators, and case managers are doing in primary care and how that connects with the asthma home visitors and asthma community health workers. Nethersole said that cost trade-offs (or gains)
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From page 59... ...
It is important to build a web of capability around them. In response to a question about the inclusion of school nurses in the coordination of care, Reid said that the e-referral pilot project includes communication between community health centers and school nurses so that the nurse has the asthma action plan for the child.
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Nethersole said that there was a lot of discussion about what information should be shared on a referral form for the Asthma Home Visit Collaborative. There needs to be enough information to inform the process for the visiting health worker.
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From page 61... ...
Reid said that some of the residency programs send their medical residents to conduct home visits and inspections with public health staff. A webcast participant asked whether community health workers are trained to look for lead hazards or are required to report lead hazards that they find in the course of an asthma home assessment.
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