Asthma in Harlem

• Prevalence rate in Harlem is among the highest in the U.S.:

– #1 Reason kids miss school and are hospitalized!

• As high as 30% compared to 8% in NYC, 4% in the rest of the country

• African American and Hispanics, most affected

• Poverty, particularly poor housing conditions, main factor

Context • Started in 2001 as a collaboration among Harlem

Children’s Zone Inc., Harlem Hospital Center, Columbia University

• Funded by Robin Hood Foundation

• Columbia University, Mailman School of Public Health, Biostatistics Department

• Key partners: NYC Department of Health, Volunteers of Legal Services, Lawyers Alliance, Single Stop, Fund for the City of New York

Care Coordination• Home visiting conducted by Community Health

Workers (culturally, linguistically competent)• Partnerships with schools, CBOS, Daycares,

hospital• Education (medication, home environment)• Link to primary and specialty care providers• Referrals to:– Legal services– Integrated Pest Management– Social Services

Scope

• Families of children (ages 0-18) who live in or attend school in Harlem

• Original catchment area 24 blocks, one charter school network

• Now over 900 kids, more than 600 families and 282 schools

Results• Percentage of kids admitted to the ER decreased

by more than half

• Percentage of kids admitted to the hospital overnight decreased by 79%

• The proportion of kids who reported missing school within the last 14 days decreased from 21% to 11%

• Smoking inside the home-known to cause asthma in children—decreased from 7% to 1%

Asthma Symptoms

Wheezing or Tightness

Had to slow down

Woke up Missed school Missed school due to asthma

ER Visit Hospital Admit

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Change in asthma symptoms after 12 months

Baseline12 months

Asthma-related symptoms

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Environmental Triggers

Dust Mold Mice Roaches Spray Bombs

Incense Smoking Perfume0

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Change in environmental triggers after 12 months

Baseline12 months

Environmental trigger

Perc

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Data: Problems

• No internal data capacity before 2011– Didn’t know how many families– No link between outreach and enrollment

• Paper-based/Scantron system; one person could enter data

• Third-party warehousing• Dependent on researchers for analysis• Last publication: 2005

Data: Solutions

• Built custom database with new reporting • Decentralized entry • Netbooks with 3g connection• Paperless • Shortened visit time• Built capacity for our own statistical analysis,

now ready again to work toward publication of lessons learned