Podcast Interview Transcript
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In each volume of the Journal, the editors select one article for our Beyond the Manuscript post-study interview with the authors. Beyond the Manuscript provides the authors the opportunity to tell listeners what they would want to know about the project beyond what went into the final manuscript. The associate editors who handled the articles conduct our Beyond the Manuscript interviews.
Beyond the Manuscript podcasts are available for download at the Journal’s website at http://pchp.press.jhu.edu. This issue’s Beyond the Manuscript podcast was conducted by REACH special issue Guest Editor Leandris Liburd and features Susan Sommer, Laurie Stillman, and Polly Hoppin, the lead author and community partners for “Children’s Hospital Boston Community Asthma Initiative: Partnerships and Outcomes Advance Policy Change” The following is an edited transcript of the Beyond the Manuscript podcast.
Susan, can you provide a brief summary of your asthma project, including its purpose and any results you’ve found for everybody who is listening to give them an orientation to the project?
The Children’s Hospital Boston Community Asthma Initiative was founded as the result of an extensive community needs assessment back in 2003 and 2004. At that time, the community identified asthma as one of their four major pediatric concerns; in addition, from Children’s perspective, asthma was the number one cause of hospitalizations, and 70% of those children came from the five low-income neighborhoods very close to the Hospital. We also noted that there were very high rates for Latino and Black children, and in fact, three to five times the rate for White children. So there was a very marked health disparity that needed to be addressed and many social determinants of health that were underlying these statistics.
We identified four ZIP Codes within inner city Boston, largely African American and Latino communities, who were the populations hardest hit by these asthma rates. And at that point consulted, (and then we’ll get into this more) with many of our already existing partners and people working on asthma issues throughout the city and region as to how to go about addressing these disparities.
As a result, we developed a case management model with a strong home visiting component. Home visits were conducted by both nurses and community health workers, and delivered tailored asthma education as well as home environmental assessments, and a moderate level of remediation. Thanks to our partners, we had built in a strong evaluation component including cost analysis, and had very positive results, with a 79% reduction in hospitalizations, and a 64% reduction in emergency department visits after 1 year as well as a return on investment of 1.46. [End Page 337]
We realized from the beginning that there were larger, systemic, policy issues that needed to be addressed. Certainly, many of them housing issues—a lot of substandard housing with many environmental triggers. We are active in coalitions working on that, but also looking for sustainable payment models for these kinds of asthma programs that clearly were very effective, but were really limited by grant funding. That’s where we turn to our partners and coalitions to work on that policy issue.
These are quite impressive findings. You had a team of partners, and I know they included community as well as academic partners, that represented different disciplines and backgrounds. How was this an asset for the project?
We did, in fact, have a strong group of partners even before our particular project started, including the Boston Public Health Commission that was doing a lot of work around home environmental triggers, and in particular pests and mold in the houses. Inspectional Services, Boston Medical Center, and then a local advocacy group, Boston Urban Asthma Coalition was its name at the time. And then in addition, the Asthma Regional Council which is represented by Laurie Stillman today, and UMass Lowell represented by Polly Hoppin, who were instrumental in helping us set the policy agenda
The Asthma Regional Council of New England is a coalition of governmental, academic, and...
