National Heart, Lung and Blood Institute funds Asthma Coalition to improve asthma care among high-risk populations
New York, NY -- June 1, 2000 -- Columbia Presbyterian physicians have launched an aggressive new project to help Washington Heights/Inwood residents with asthma control their illness and live symptom-free. The Columbia University Asthma Coalition, a three-year project funded by the National Heart, Lung and Blood Institute (NHLBI), is the first outreach project to target the largely Dominican-American community. Columbia joins six other research centers in a national effort to eliminate socioeconomic and ethnic disparities in asthma deaths and illnesses.
Columbia Presbyterian Medical Center (CPMC) has several programs in place to help children and adults with asthma. But many limitations remain. In fact, research based on a survey of adult patients with asthma in the Columbia Presbyterian emergency room found that 60 percent did not have a primary care physician, even though 90 percent had insurance, and that only one-third of patients were using medications to control their asthma.
"We want to identify patients who don't know they have asthma, or don't see it as a chronic disease, and let them know that in many cases they can completely control their symptoms," says Dr. Emily DiMango, the principal investigator of the project, assistant professor of clinical medicine at Columbia University College of Physicians & Surgeons, and assistant attending physician at Columbia Presbyterian Medical Center of New York-Presbyterian Hospital. Dr. DiMango is also clinical director of the John Edsall/John Wood Asthma Center at CPMC.
The coalition will use a three-pronged approach to improve asthma care. Researchers will implement a multi-disciplinary, culturally appropriate program for high-risk patients with asthma; seek to increase public awareness of asthma and use community outreach to identify residents who are ill with asthma; and form partnerships with primary care providers for implementation of National Asthma Education and Prevention Program (NAEPP) guidelines in the care of asthmatic patients.
"This is the first step in a broader plan to build a network of coalitions in high-risk communities to work together towards achieving the Healthy People 2010 goals of eliminating racial and ethnic disparities in health care," says NHLBI Director Dr. Claude Lenfant.
Asthma is a chronic condition in which the airways become inflamed, interfering with breathing. Prevalence of this serious illness is particularly high in inner-city communities and among African-American and Latino individuals. Although several triggers for asthma attacks have been identified, such as dust, pet hair, and air pollution, the underlying cause of the disease is still not understood. Most people with asthma can control their symptoms completely by using maintenance medications that limit airway inflammation. However, poor compliance is seen in people who are not adequately educated about treatments and the use of medications. Also, not all physicians are aware of how best to treat and control the illness.
One of the first major goals of the new program will be to work with high-risk asthma patients and offer a broad range of services to help them build a relationship with a nurse or doctor and thus feel connected with the health care system rather than alienated and intimidated by it. High-risk patients will be identified through hospitalizations and frequent emergency room visits. Patients will meet with an asthma nurse educator and receive instruction on how to use asthma devices, such as peak flow meters and inhalers. Because depression and anxiety can worsen asthma and also limit a person's ability to seek care, each person will see a social worker who can make referrals to mental health treatment when appropriate and help uninsured patients enroll in Medicaid or alternative programs. Patients also will receive home visits by a nurse, who will check the home for potential asthma triggers and provide advice on how to minimize them.
The second challenge -- and perhaps the most difficult -- of the program will be to identify people with undiagnosed or untreated asthma. The coalition will employ community health educators to build asthma awareness and help people in the community get care. Using funds provided by the grant, Columbia will hire and train two community outreach workers through Alianza Dominicana and West Harlem Environmental ACTION Group (WEACT), two long-standing local community service agencies. The educators, who will be bilingual and bicultural, will work with churches, schools, tenant associations, and other community institutions to plan forums on asthma. They also will carry out a targeted, house-to-house intervention for a single five-block area of Washington Heights that has been identified as having the highest number of emergency room admissions for asthma treatment.
The third goal of the coalition is to hold a series of events offering training in the NIH guidelines along with continued medical education credit to local primary care physicians. The coalition also will use a variety of mechanisms, such as surveys, quality-of-life questionnaires and asthma knowledge quizzes, to evaluate the effectiveness of the three-year asthma initiative as it progresses.
The grant will establish a Washington Heights/Inwood Asthma Advisory Board, to be staffed by volunteers who will guide the coalition in the dissemination of NAEPP guidelines to local physicians and residents. The board also will work with WEACT and Alianza Dominicana to address environmental problems that may be worsening asthma in the neighborhood.
The six other local asthma coalitions are based in Little Rock, Ark.; Fresno, Calif.; Chicago, Ill.; Indianapolis, Ind.; Atlanta, Ga.; and Tacoma, Wash.