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An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children

Reddy, Amanda L. MS; Gomez, Marta MS; Dixon, Sherry L. PhD

Journal of Public Health Management and Practice: March/April 2017 - Volume 23 - Issue 2 - p 219–228
doi: 10.1097/PHH.0000000000000530
Special Section: Evaluating the Impact of the New York State Healthy Neighborhoods Program: Research Articles

Context: Reducing exposure to environmental triggers is a critical part of asthma management.

Objective: To evaluate the impact of a healthy homes intervention on asthma outcomes and assess the impact of different targeting strategies.

Setting: The New York State (NYS) Healthy Neighborhoods Program (HNP) operates in select communities with a higher burden of housing-related illness and associated risk factors.

Participants: Residents with asthma were recruited through 3 mechanisms: door-to-door canvassing (CANVASSED), 752 residents in 457 dwellings; referrals from community partners (REFERRED), 573 residents in 307 dwellings; referrals of Medicaid enrollees with poorly controlled asthma (TARGETED), 140 residents in 140 dwellings.

Intervention: The NYS HNP provides visual assessments and low-cost interventions to identify and address asthma triggers and trigger-promoting conditions in the home environment. Conditions are reassessed during a revisit conducted 3 to 6 months after the initial visit.

Main Outcome Measure(s): The analysis compares improvements across the 3 groups for measures of asthma self-management, health care access, morbidity, and environmental conditions. An asthma trigger score characterizing the extent of multiple triggers in a dwelling was also calculated.

Results: Among 1465 adults and children, there were significant improvements in environmental conditions and self-reported self-management, health care access, and asthma morbidity outcomes for each group. The improvement was greatest in the TARGETED group for most outcomes, but selected measures of self-management and health care access were greater in the other groups. The mean improvement was significantly greater in the TARGETED group.

Conclusion: Targeting the intervention to people with poorly controlled asthma maximizes improvements in trigger avoidance and asthma morbidity; however, other recruitment strategies are effective for impacting endpoints related to health care access and self-management. This evaluation demonstrates that a low-intensity home-based environmental intervention is effective as well as practical and feasible. Health care payers, state and local health departments, and others should consider investing in these home-based services as part of a comprehensive asthma care package.

Supplemental Digital Content is Available in the Text.

National Center for Healthy Housing, Columbia, Maryland (Ms Reddy and Dr Dixon); and New York State Department of Health, Albany, New York (Ms Gomez).

Correspondence: Amanda L. Reddy, MS, BA, National Center for Healthy Housing, 10320 Little Patuxent Pkwy, Ste 500, Columbia, Maryland 21044 (areddy@nchh.org).

The authors thank the staff and participants of the New York State (NYS) Healthy Neighborhoods Program and, in particular, Kenneth Boxley, Philip DiMura, Joan Bobier, Thomas Carroll, and Michael Cambridge, and the many residents who welcomed the program into their homes. The authors acknowledge the NYS Asthma Control Program, the NYS Office of Health Insurance Programs, the Erie County Department of Health, and the regional Medicaid Managed Care Plans that participated in the Healthy Home Environments for New Yorkers with Asthma (HHENYA) pilot initiative in Buffalo, New York. The authors are also grateful to David Jacobs and Jonathan Wilson for providing feedback on the manuscript.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://www.JPHMP.com).

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.