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CABS Awarded by OneCity Health Innovation Fund

Developing an Asthma Smartphone Application Targeting Children and Families with Low Health Literacy: The “AsthMe Ask Me!” Program

LEAD ORGANIZATION:

NYC Health + Hospitals / Kings County

JOINT APPLICANTS:

University Hospital of Brooklyn; CABS Home Health Attendants Services, Inc.

NEIGHBORHOODS PROJECT INTENDS TO SERVE:

Central Brooklyn (East Flatbush, Flatbush, Crown Heights, Bedford-Stuyvesant, Canarsie, East New York, Brownsville)

Overview

Low parental health literacy is associated with unfavorable pediatric asthma outcomes. A recent systematic review on literacy and child health reported that most written health information is at a third to fifth grade reading standard. Pictorial aids have been shown to increase patient attention, comprehension, recall, and treatment adherence. Phone apps can be a powerful tool for asthma home management by incorporating pictures and algorithms with simple navigation. We will develop an asthma smartphone application targeted to patients and caregivers with low health literacy to increase understanding of pediatric asthma and its management. Our target population will be children with asthma (ages 5-18) and their caregivers with emphasis on families enrolled in the DSRIP Asthma Home Management program. The application called “AsthMe” will consist of a variety of images or videos, including:

  • Asthma education simplified with pictures
  • Pictorial pick-list of all available asthma medications which can be selected, stored, and easily accessed and edited
  • Pictorial symptom diary (including Emergency Room/hospitalization checkboxes)
  • Pictorial pick list of asthma triggers
  • Peak flow tracker
  • An asthma action plan simplified with the ”faces pain scale”
  • Pictures of the medications to be used based upon symptoms
  • Spacer use video

DSRIP Metrics This Project Will Address

The DSRIP Asthma Home-Based Self-Management Program aims to reduce avoidable ED use and hospitalization related to pediatric asthma through providing home-based interventions; however, addressing low health literacy as a barrier to self- management is currently not a specific target of this program. Our project seeks to improve symptom control for children with persistent asthma, with the goal of better quality of life including less missed school days, decreased ER usage and reduced hospitalization for acute asthma. With the assistance of community health workers (CHW’s), families will use the AsthMe application to complement the in-home interventions provided by the CHW’s.

Additional Articles

OneCity Health Awards Eight Community Partners with $5 Million in Innovation Funds

NYC Health & Hospitals Official Press Release

OneCity Health Launches City-wide Program to Better Treat Kids with Asthma and Reduce Avoidable Hospitalizations

NYC Health + Hospitals/OneCity Health today announced the launch of a population health and care management program designed to reduce hospitalizations among New York City children who suffer from frequent or severe asthma attacks. The home-based environmental management program assigns community health workers to visit homes to identify asthma triggers, reinforce strategies to help patients and their families maintain control over asthma, and supply free pillow cases, special cleaning supplies, and professional pest control services as needed.

OneCity Health—a subsidiary of NYC Health + Hospitals focused on population health, care management, and implementation of the State’s Delivery System Reform Incentive Payment (DSRIP) program—is aligning the public health system and its community partners, having already completed its first 500 home assessments, with plans to expand the program to hundreds more children and families this year.

“Asthma is the third-leading cause of hospitalization among children under the age of 15 in the United States, and oftentimes it’s because families may not understand how to reduce triggers or may struggle to address underlying determinants of health, such as substandard housing conditions,” said Dr. Luis Rodriguez, Chief of Pediatrics at NYC Health + Hospitals/Woodhull. “Controlling asthma requires getting to the root of the issue, including triggers in the home, and ensuring patients have access to the proper medications.”

“Through these transformation initiatives, which were enacted through the DSRIP program, we are connecting primary care physicians with community health workers and home remediation services, helping professionals across these organizations work together to care for patients with asthma,” said Andrew Kolbasovsky, Chief Program Officer, OneCity Health. “Our goal is to improve the quality of life for affected children, making sure they don’t miss school or avoid physical activity due to their asthma. That begins with creating a care plan focused on prevention, making sure patients don’t need to come to the emergency department or spend the night at the hospital because of asthma attacks.”

“Community partners and community health workers are essential to engaging patients,” said Janise Germosen, LMSW, Community Health Worker Supervisor and Social Work Care Manager at Asian Community Care Management, a OneCity Heath community partner. “We know our communities well and have done outreach before, so patients are more comfortable allowing us into their homes, which is an important element of support in the program.”

The home-based environmental management program for children with asthma is run in part by CABS Home Attendant Services.

The program’s initial focus is on pediatric patients with poorly controlled asthma, defined as overuse of “rescue” medications, use of systemic corticosteroids two or more times in the last six months, two or more asthma-related emergency department visits in six months, or hospitalization related to asthma in the past year. Program data will be tracked, including the impact on the proper use of medication and reduction in asthma-related hospitalizations, both DSRIP priorities.

After identifying a patient with frequent or severe asthma attacks, the primary care team develops an Asthma Action Plan and refers the patient to a community health worker. The community health worker meets with the patient and reinforces recommendations from the clinical team, including self-monitoring strategies and instructions on the correct use of medications. In addition, the community health worker conducts a home visit to evaluate the environment for asthma triggers, such as rodents, pests, mold, and dust. Based on the assessment, the community health worker can provide pillow cases and cleaning supplies, instruct families in home-cleaning strategies, and engage with the New York City Department of Health & Mental Hygiene—OneCity Health’s partner providing professional cleaning and pest management—at no cost to the patient.

Community health workers ensure that patients and their families are adhering to the Asthma Action Plan on an ongoing basis, through both home visits and phone calls. The community health workers also communicate with each patient’s clinical care team, using care management software to document interventions and receive alerts when patients are in the hospital.