Funded Projects

Environmental Equity through Asthma Trigger Remediation

Project Year

2023

City & State

Greensboro, North Carolina

Program Name

CATCH Resident

Topic

Environmental Quality (LHI)

Program Description

The Problem: Our CATCH grant targets environmental inequity in Greensboro, NC that leads to worse asthma outcomes for our pediatric population. Healthy housing has been defined as housing that is “designed, built, renovated, and maintained in ways that support the health of residents.” (1) Housing quality is an important social determinant of health that needs to be considered. Racial and ethnic minority populations are more likely to reside in substandard housing or in poor conditions that contribute to environmental health (1). Substandard housing goes hand and hand with asthma. Asthma is one of the leading chronic illnesses of childhood and increasingly impacts lower income communities. Multiple exposures that contribute to pediatric asthma morbidity include exposure to pest allergens, mold, endotoxin, and indoor and outdoor air pollution. These factors play a large role in asthma sensitization and development of asthma. One study suggested that eliminating all the factors within substandard housing conditions that contribute to asthma would result in a 39% decrease in asthma prevalence (5). Primary Setting and Number of Children Affected: This project will serve children, ages 2 -18, living in specific neighborhoods of Greensboro, NC, which put them most at risk for developing asthma or complications from asthma due to their living conditions. (7,8) We will target specific zip codes (27401, 27405, 27406) most impacted by inequitable housing conditions. An estimated 20,000 children live in substandard housing (7). Due to generations of redlining and systemic racism, the resulting environmental disparities further exacerbate health disparities including in asthma. Project Goal: This project will connect patients with asthma to a community partner to remediate unsafe housing conditions. We will work with the Greensboro Housing Coalition (GHC) and directly with patients and families to implement a referral, education, and remediation process for children with asthma living in specific neighborhoods of Greensboro, NC. This partnership will allow patients to have more agency in obtaining equitable housing conditions and diminish their disease burden. Proposed Intervention: We will create a standardized referral process to GHC within the outpatient Pediatric Pulmonology clinic at Cone Health. Patients fulfilling the criteria (age, zip-code, diagnoses) will be referred to GHC for asthma remediation and education services. GHC will use an assessment form created in collaboration with our team (see attached) to evaluate the asthma history of the patient and their home environment. Once the assessment is completed, GHC will complete remediation steps (detailed later) to address issues in these homes that may be contributing to further asthma exacerbations. GHC will follow-up at the 30- and 90-day mark with the patients’ families to assess if their remediation steps have produced any changes in health outcomes. Lastly, we will have quarterly focus groups that include GHC, our group, and patients utilizing the service to improve the referral process and assess the success of the GHC interventions. The CATCH grant money will be used to support the asthma education materials for families, provide supplies to complete the Tier 1 remediation steps*, and support the quarterly focus groups. Over time, we are hopeful to expand this standardized referral process to the inpatient pediatric wards as well as our primary care clinic. Finally, we are hopeful to eventually share the results of this partnership with the Greensboro community in hopes of increasing awareness about the utility of these services. Anticipated Outcomes: Our anticipated outcomes are to 1) increase the referral of eligible children with new or poorly controlled asthma to the Greensboro Housing Coalition, 2) increase the percentage of referred children receiving services promptly, 3) increase patient/family satisfaction with asthma remediation/education services, and 4) increase patient/family knowledge related to modifiable environmental asthma triggers.

Project Goal

Improve the quality of life of Greensboro’s most vulnerable children by reducing the prevalence of asthma exacerbations caused by unhealthy housing conditions. By reducing the frequency and severity of asthma exacerbations, we hope to increase school performance and improve quality of life for a segment of Greensboro’s child population that faces an undue burden of health disparities. In addition, through targeting racial and health inequity in asthma care, we hope to reduce healthcare utilization and costs for the healthcare system. In pursuit of the above goal, sub-goals include standardizing the referral process to Greensboro Housing Coalition through partnership with Cone Health Pediatrics, incorporating community partner and patient feedback to make this referral process as equitable and accessible as possible, and measuring the success of this referral through patient feedback.

Project Objective 1

Increase the referral of eligible children (ages 2-18) living in zip codes 27401, 27405, and 27406) seen in Cone Health Pediatric Pulmonology clinic for asthma by 50% by month 6 after initiation.

Project Objective 2

In the eligible patients referred to GHC for asthma remediation, 75% will receive asthma education and remediation services within 30 days of the referral being placed.

Project Objective 3

In patients and families who receive asthma education and remediation services, 50% will rate services received as “helpful” or “very helpful”; 60% will report an increase in knowledge about modifiable environmental asthma triggers.

AAP District

District IV

Institutional Name

Cone Health

Contact 1

Caitlyn Gold

Contact 2

Alexandria Card