Seattle-King County Healthy Homes is an evidence-based approach for controlling asthma among low-income children.
The first aim of our proposal is to translate the research-based model into practice, assess the impact of translation on the asthma-related outcomes included in evaluation of the original model, and describe the translation process.
Our second aim i s to assess the cost-effectiveness and return on investment (ROI) of the translated model. We hope to demonstrate that Healthy Homes is a replicable and cost-effective model that can be provided to all children with uncontrolled asthma insured by Medicaid. Background: Asthma remains the most common chronic condition of childhood, affecting 9.1% of all American children. The rate of asthma has doubled since 1980 and remains at historically high levels. Asthma education is effective in reducing asthma morbidity and urgent health services utilization. The National Institutes of Health has identified it as a core asthma control strategy. However, many children with asthma and their caretakers do not participate in asthma education because of access barriers. Offering education in the home may increase participation. Recent research shows that providing asthma education through home visits results in reductions in asthma symptoms and urgent health care utilization. The CDC Guide to Community Preventive Services recently recommended home visits as an effective intervention. A major barrier to wider implementation of the home visit approach is lack of reimbursement for this service by health care payers, who need evidence of the ROI of this intervention. Intervention: A community health workers (CHW) will visit 200 Medicaid-insured children with uncontrolled asthma in their homes over a year. A CHW is a peer educator who provides tailored, culturally-appropriate asthma education. She will assess current asthma control status, self-management practices and the presence of asthma triggers in the home and help children and their caretakers use medications more effectively, prevent and manage exacerbations, facilitate access health services and communication with providers, and reduce exposure to asthma triggers. They will provide participants with tools to reduce exposure to triggers (e.g. a vacuum). Another important role will be provision of instrumental, informational and emotional support. Evaluation: We will use the RE-AIM framework and community-based participatory research methods to assess the translation process. We will complete a quasi-experimental study to assess the cost-effectiveness and ROI of the intervention using administrative claims and self-reported asthma control data.

Public Health Relevance

Information on the cost-effectiveness of CHW home visits for asthma will enable policy makers to assess the health and economic benefits of providing this service to all children with uncontrolled asthma who are insured by Medicaid. Home visits have the potential not only to improve children's health but also to reduce Medicaid expenditures.

National Institute of Health (NIH)
National Center for Environmental Health (NCEH)
Research Demonstration and Dissemination Projects (R18)
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Special Emphasis Panel (ZEH1-JXS (07))
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Mehta, Paul
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Seattle-King County Public Health Department
United States
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Campbell, Jonathan D; Brooks, Marissa; Hosokawa, Patrick et al. (2015) Community Health Worker Home Visits for Medicaid-Enrolled Children With Asthma: Effects on Asthma Outcomes and Costs. Am J Public Health 105:2366-72