Community development initiative reduced rates of high-cost care, study finds

More than a decade into the community development initiative called Healthy Neighborhoods Healthy Families, the 30-block Southern Orchards neighborhood on Columbus, Ohio's South Side had clear, notable improvement. Home vacancy fell from 30% to under 6%. High school graduation rates increased. More than $40 million in investments were generated in the area.

But Nationwide Children's Hospital, a lead partner in the initiative, had a question. Had the neighborhood improvement also improved the health of the children in it?

A new study, published July 7 in Pediatrics, finds that the rate of emergency department visits decreased 20.8% and inpatient admissions decreased 12.7% in the neighborhood from the baseline period of August 2008 - July 2010 to the follow-up period of August 2015 - July 2017. There was also a 28.9% increase in inpatient length of stay. These changes compared favorably to two neighborhoods with similar housing, racial segregation and socioeconomic conditions, where the authors found a 16.1% decrease in ED visit rate; a 12.2% decrease in inpatient admissions; and a 36.6% increase in length of stay.

All three neighborhoods showed changes in use, but Southern Orchards fared slightly better.

This is not surprising. Health care changed broadly over the past decade. More people are insured as a result of the Affordable Care Act. There's a been general focus on improving quality of care to keep people out of emergency departments. Perhaps most importantly in central Ohio, Nationwide Children's has implemented a number of region-wide programs that have affected health and health care."

Deena Chisolm, PhD, lead author of the study and director of the Center for Innovation in Pediatric Practice at the Abigail Wexner Research Institute at Nationwide Children's

The Healthy Neighborhoods Healthy Families initiative was specific to the Southern Orchards neighborhood in that time period (it has since expanded), and its primary intervention was housing improvement. More than 380 homes have been built, renovated or otherwise improved since 2008, with Nationwide Children's and the faith-based organization Community Development for All People as the major partners in the initiative. Workforce training and job placement, community-based mentoring and other programs were implemented as well.

None of those interventions were specifically designed to improve health care utilization, but links between neighborhood exposures and health are well-known, said Dr. Chisolm, who is also an associate professor of Pediatrics at The Ohio State University College of Medicine. A number of other Nationwide Children's-led programs were designed, however, to improve health care utilization - and those programs were active in the Healthy Neighborhoods Healthy Families district, the two comparison neighborhoods, and throughout the Columbus area.

"Overall, the study is very good news for this area," said Kelly Kelleher, MD, holder the Chlapaty/ADS Endowed Chair for Innovation in Pediatric Practice at Nationwide Children's and senior author of the study. "We're reducing ED use and inpatient admissions across traditionally at-risk areas of Columbus. In one neighborhood, we have the added element of housing, which appears to have an additional benefit, even if it's small. It will be interesting to see what effect Healthy Neighborhoods Healthy Families in the future, now that the program is fully developed and continues to grow."

Drs. Chisolm and Kelleher point out that Healthy Neighborhoods Healthy Families started slowly, with 23 homes total improved over the first two years, but the initiative has more recently averaged of 34 homes per year and accelerated its investments in rental units and other areas, such as workforce development. The authors also say that this kind of measurement of neighborhood-level outcomes is difficult and may become clearer over time.

"Going forward, housing and neighborhood improvement interventions may produce even greater in health care utilization," said Dr. Chisolm. "As we address many of the obvious drivers of ED usage, such as asthma, we may now find that these neighborhood-level changes have an increased impact."