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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
0
10
20
30
40
50
60
70
80
Change in asthma symptoms after 12 months
Baseline12 months
Asthma-related symptoms
Perc
enta
ge o
f par
tici
pant
s ex
peri
enci
ng s
ympt
oms
Environmental Triggers
Dust Mold Mice Roaches Spray Bombs
Incense Smoking Perfume0
10
20
30
40
50
60
70
80
90
100
Change in environmental triggers after 12 months
Baseline12 months
Environmental trigger
Perc
enta
ge o
f hou
seho
lds r
epor
ting
issue
s with
trig
gers
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
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