ARC Environmental Investments Publications
Investing in Best Practices for Asthma: A Business Case for Education and   
   Environmental Interventions (new!)

Enhancing Asthma Management Using In-Home Environmental Interventions:
   A Review of Public Health Department Programs

Health Payer Perspectives on Environmental Interventions
Resarcher Perspectives on Environmental Interventions
Improving Asthma Management by Addressing Environmental Triggers: 
    Challenges and Opportunities for Delivery and Finance

Overview

Four years ago, ARC launched the Environmental Investments Project. This unique initiative seeks to bring representatives from the health care sector (specifically public and private payers) together with environmental researchers to better understand the health and cost benefits of home-based interventions that help to reduce asthma exacerbations. The project has three objectives: First, to educate public and private payers in New England regarding the role that preventive environmental measures and self-guided patient education can play in controlling asthma; second, to move research into practice by building an important (and currently neglected) bridge between the information needs of health payers on the one hand and the clinical researchers investigating best practices in asthma on the other; and third, to bring together all the partners who are currently investing in asthma -- including purchasers, employers and providers, as well as payers -- to discuss and better understand how these investments can best be implemented and allocated across sectors.

The rationale for such a project is twofold:

First, the vast majority of funds spent on asthma currently support medical management. While quality care is critical in controlling asthma in a given individual, and major efforts to improve the quality of asthma care are underway nationwide, environmental interventions that could prevent asthma exacerbations and reduce severity are rarely given the same level of attention by clinicians. At the same time, the body of research on the effectiveness of environmental interventions, and robust educational programs, in reducing asthma exacerbations and severity is rapidly expanding. For the most part, based on our research, primary care practitioners and payers are not always familiar with the evolving research and practice.

Second, coverage policies for asthma do not necessarily reflect the current state of understanding of best practices. Moreover, traditional health care financing mechanisms and institutional relationships may impede the rational distribution of costs and benefits associated with environmental interventions. Their emphasis is often on treatment, rather than prevention.

We have a four-point action plan:

1) We conducted structured interviews of public and private payers on their receptivity to and knowledge of environmental interventions that can control both costs and the frequency of asthma attacks. We also conducted interviews with environmental researchers to determine how they view the state of the science and to what extent they develop their research with policy and practice objectives in mind. The results are available on this page.

2) We developed White Papers, Improving Asthma Management by Addressing Environmental Triggers: Challenges and Opportunities for Delivery and Finance and Enhancing Asthma Management Using In-Home Environmental Interventions: A Review of Public Health Department Programs, summarizing the emerging research on the benefits of specific environmental approaches and highlighted programs and financing options which New England health payers may want to pursue. We also documented model public health programs around the country successfully engaged in this work. Finally, we just released our newest report (April 2007): Investing in Best Practices for Asthma: A Business Case for Education and Environmental Interventions. This highly-acclaimed publication documents the cost benefits of payers investing in best practices, including environmental strategies. All of the research was conducted in collaboration with the University of Massachusetts/Lowell’s Environmental Health Initiative.

3) The White Papers informed two ARC-sponsored symposia, with support from the US DHHS-Reg. I office. The first was held in December 2004 entitled Environmental Controls in Asthma Management: Implications for Health Care Policy and Practice . This symposium addressed two issues: Facilitating the translation of research into practice by fostering communication mechanisms between clinicians and payers, and stimulating new ways of approaching this emerging field of chronic disease management. A number of Medicaid managed care organizations have begun adding home-based environmental assessment and intervention programs following this symposium. The second, held in September 2006, was entitled Connecting Asthma Care from the Clinic to the Community: A Role for Public Health Departments and their Partners. The symposium provided practice models for state and local health departments on improving asthma care and its environmental triggers.

4) ARC now wants to more robustly move research and policy for best asthma management into practice in the region. We will use the relationships that we have built over the last four years with the health sector, and utilize the tools that we have developed, to promote a more sustainable financing system of community-based asthma programs in New England through voluntary policy change.

Other Items of Interest

• ARC PowerPoint Presentation: Health Payer and Environmental Researcher Perspectives on Environmental Interventions.

• AAP Pediatricians' "Green Book" on Childhood Environmental Health Problems." See http://www.aap.org/bookstore

• AHRQ Guide for Improving the Quality of Asthma Care: A Resource Guide and Workbook for State Action

http://www.ahrq.gov/QUAL/asthmaqual.htm

• Asthma Action Plan (English & Spanish)
  Step-Wise Approach to Managing Asthma, Controlling Asthma Triggers

http://www.pacnj.org/

• Asthma Health Outcomes Project (AHOP) report

http://www.epa.gov/asthma/ahop.html

• Asthma information and resources for the patient and health care professional

• http://www.aaaai.org/patients.stm

  http://www.aaaai.org/professionals.stm

• Basic Facts About Asthma - English
  Basic Facts About Asthma - en Espanol

http://www.cdc.gov/asthma/faqs.htm (English)

http://www.cdc.gov/asthma/spanish/sp_faqs.htm (Spanish)

• Canadian Institute for Health Information and the Canadian Mortgage and Housing Corporation, "Housing and Population Health:  The State of Current Research Knowledge"

• Communities in Action for Asthma Friendly Environments Network
  
• Etzel, R.A., "How Environmental Exposures Influence the Development and Exacerbation of Asthma." Pediatrics: 2003, 112: 233-239.

• Effectiveness of Community Health Workers in Addressing Environmental Asthma Triggers

Krieger, et al, Seattle Healthy Homes Study, 2005

• EPA's Communities in Action for Asthma-Friendly Environments Online Network
  http://www.asthmacommunitynetwork.org/

• Improving the Quality of Asthma Care. New Tools for States, April 2006

http://www.ahrq.gov/qual/asthqguide.pdf

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• National Center for Environmental Health, "Potentially Effective Environmental Interventions for Asthma."

See http://www.cdc.gov/asthma/interventions.htm

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• New Study Shows Effectiveness of Environmental Controls in the Home of Inner City Children with Asthma

http://www.nih.gov/news/pr/sep2004/niaid-08.htm

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• Potentially Effective Interventions for Asthma

www.cdc.gov/asthma

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• Sandel, Phelan, Wright, Hynes, and Lanphear, "Housing Interventions and Child Health:  A Critical Review"

• Student Asthma Action Card Asthma Fact Sheet

http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/asthma_actionplan.pdf

Info for Health Care Providers and Plans

American Association of Health Plans Survey on Approaches to Asthma Management

http://www.takingonasthma.org/Coverage2005asthmaarticle.pdf

Asthma information and resources for the patient and health care professional

http://www.aaaai.org/patients.stm

http://www.aaaai.org/professionals.stm

Asthma Management programs in health plans (AHIP 2007)
http://www.takingonasthma.org/pdf/Cov507Breathing.pdf

Brugge D, Bagley J, Hyde J. Environmental management of asthma at top-ranked
U.S. Managed Care Organizations. Journal of Asthma. 2003; 40:605-614

Cost Effectiveness of Home Environmental Interventions

Journal of Allergy & Clinical Immunology. 2005; 116(5):1058-63 (ISSN:  0091-6749)

Cultivating a Successful Pediatric Asthma Initiative

Environmental Health Tools for Pediatric Health Care Providers
www.neetf.org/health/champions

Environmental History Form for Pediatric Providers

http://www.neetf.org/Health/neetf_pehi_files/HistoryForm.htm

Environmental History Taking Primer

http://www.neetf.org/Health/primer.pdf

Environmental Management of Pediatric Asthma:  Guidelines for Health Care Providers, 2005

http://www.neetf.org/Health/asthma.htm

Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers Patient Education Material Assessment Tool

http:://www.asthma.umich.edu/

EPA's Asthma Home Environment Checklist for Asthma Educators. Click here to view with Adobe Acrobat

EPA Asthma Resources for Health Professionals

http://www.epa.gov/asthma/healthcare.html

EPA's Health Plan Guide for Implementing a Home Visiting Program

http://www.epa.gov/asthma/hcprofessionals.html#Conduct

http://www.epa.gov/asthma/pdfs/implementing_an_asthma_home_visit_program.pdf

Free Environmental Training for Providers Serving Low Income Communities Association of Clinicians for the Underserved

Contact:  Jennifer Sheen, 703.448.8528

Free on-line course for clinicians and educators on managing asthma triggers.

See http://www.aaaai.org/members/cme_ce/environmental_management/

Improving Asthma Care for Children: Best Practices in Medicaid Managed Care

from the Center for Health Care Strategies

Physician referral system for housing interventions for asthmatics.

Housing and health counselling:  Preliminary results of a new medical referral system in France

Predictors of Funding Sustainability for Home-Based Asthma Programs

MCO Purchasing Specifications for Children with Asthma

http://www.gwhealthpolicy.org/newsps/asthma/asthma_specs_2.htm

Quality Asthma Care Guidelines

http://www.cdc.gov/mmwr/PDF/rr/rr5206.pdf

Taking On Asthma: A Resource Guide for Health Insurance Plans

http://www.takingonasthma.org/AsthmaResourceGuide.pdf

Learn more about exemplary asthma management programs:

http://www.epa.gov/asthma/leadership_award_winners.html