The disappearance of reliable healthcare services in New Orleans following Hurricane Katrina left many children with asthma no choice but to seek treatment in emergency rooms across town - if they sought care at all. Xavier University of Louisiana's Center for Minority Health & Health Disparities Research and Education (CMHDRE), Daughters of Charity Services of New Orleans (DCSNO) and the Children's Health Fund (CHF) have teamed up to reverse that trend by bringing reliable health care directly to these children. The organizations are partnering on the second phase of Head-off Environmental Asthma in Louisiana (HEAL), a program that has been helping New Orleans families manage their children's asthma since Katrina struck. The program is funded by non-profit Merck Childhood Asthma Network, Inc. (MCAN) and The Merck Company Foundation.
HEAL Phase II, a four-year program aimed at improving childhood asthma management in New Orleans, will use a unique, well-documented approach to deliver care through community health centers and mobile clinics placed in neighborhoods that lack a central source of healthcare. This approach is especially important given the burden of asthma on New Orleans' children. Asthma prevalence rates in New Orleans are three times higher than the national rate - among the highest in the nation - and death rates from childhood asthma are the highest in Louisiana.
"We are doing something that's never been done in New Orleans because waiting for things to return to 'normal' just wasn't an option for kids with asthma," said Leonard Jack, Jr., Ph.D., MSc, CHES, Director of the CMHDRE, Xavier University and principal investigator for HEAL Phase II. "Innovation and science-based approaches are crucial in post-Katrina New Orleans, where thousands now have the daunting task of managing health conditions like asthma in the absence of consistent healthcare and in the face of new environmental challenges."
HEAL Phase II will extend and build upon the lessons learned from the first phase, the most significant of which was that successful childhood asthma management requires access to continuous, evidence-based care that incorporates the home, healthcare setting and school. The program will enroll children (ages 2-18) who receive care at any of the DCSNO clinic locations and the Children's Health Fund-Tulane University Health Sciences Center Department of Pediatrics mobile clinic that currently serves Fredrick Douglas High School and A.D. Crossman Esperanza Charter School. HEAL Phase II will use the following elements to provide coordinated care for children with asthma and their families:
- Provider Training: Studies have shown that using the National Heart, Lung and Blood Institute asthma guidelines in practice improves health outcomes. HEAL will retain the services of an allergist who will train providers at DCSNO to enhance their skills and help them deliver care that is compliant with these guidelines.
- Asthma Educators: Asthma educators have been shown to effectively reduce the number of days with symptoms, emergency department visits and hospitalizations. During the program, two asthma educators will provide counseling to children and their families that: 1) addresses the child's specific severity of symptoms, sensitivities and exposures to allergens; 2) identifies and addresses barriers to care and empowers them to acquire the skills to effectively self-manage the disease and communicate with physicians; and, 3) includes follow-up calls between clinic appointments and home visits, where necessary.
- Electronic Medical Records: The effective use of electronic medical records can improve access to care, doctor-patient communication, efficiency and patient satisfaction. Most importantly they can decrease medical errors. Both DCSNO and CHF will implement important changes to existing electronic medical systems to enhance delivery and documentation of state-of-the-art asthma care.
- Community Outreach and Asthma Awareness: The program will use community health workers to engage schools, churches, social services and community-based organizations located near the care sites to enhance the child's network of support outside of the clinical setting.
"For years, the Daughters of Charity have been a major provider of primary care in the New Orleans area, and we are honored to be able to help residents at such a pivotal time for the healthcare system in our city," said Michael G. Griffin, President and CEO, Daughters of Charity Services of New Orleans. "This partnership will not only enhance the services we already provide to the community, but it will improve the lives of some of our most vulnerable residents - children with asthma."
In 2007, the unique conditions in New Orleans after Katrina - the flooding and subsequent proliferation of mold - prompted MCAN to launch the HEAL project alongside the National Institutes of Health (NIH). The outcome of the first phase of HEAL revealed the need to take key learnings into "real world" settings. The second phase will hopefully make the important case for incorporating training, education, evidence-based care, technology and outreach into sustainable, community-based asthma interventions across the country. In addition, partners and funders are hopeful the findings will provide a basis for advancing national policies that remove barriers to better asthma management and care.
"Since Hurricane Katrina, many children and families have had difficulty accessing health care in New Orleans. Our mobile program allows us to bring comprehensive primary and specialty care directly to children who are otherwise not getting the help they need," said Delaney Gracy, MD, Chief Medical Officer, Children's Health Fund. "Our partnership with Xavier University and Daughters of Charity Services of New Orleans brings together groups with a common interest and increases the impact any one of us could have on these kids exponentially."
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