Philadelphia Allies Against Asthma (PAAA)
Linking Families to Untapped Resources
Philadelphia, the nation’s fifth largest city, is rich in medical resources. Home to five medical schools, three children’s hospitals and multiple hospital systems, managed care plans, public health organizations and federally qualified health centers, Philadelphia would seem to have the infrastructure to care for its most vulnerable children. Yet before support from the Robert Wood Johnson Foundation spurred the creation of Philadelphia Allies Against Asthma in 2001, there existed no unified way to coordinate efforts on behalf of children with asthma. Today, representatives from all of the city’s health care organizations, together with the public schools, parents and community groups, work together through Philadelphia Allies Against Asthma to focus on the needs of children with asthma citywide.
When the more than 100 founding members of Philadelphia Allies convened in 2001, they identified a critical gap in delivering quality care to children with asthma in North and West Philadelphia. In these poor, medically under-served neighborhoods, more than 30 percent of the children between the ages of 5 and 12 have been diagnosed with asthma. While managed care organizations and health systems offered disease management programs to these families, none offered the kind of comprehensive medical and social support that addressed the other factors that can affect a family’s ability to manage a child’s asthma.
Creating the Link Line
To link families to Philadelphia’s existing resources, Allies coalition members created a free telephone hotline, the Child Asthma Link Line. Staffed by two full-time asthma care coordinators, the Link Line offers families help in both Spanish and English.
“We do a needs assessment and then we deliver asthma care coordination, which can range from helping a family get a nebulizer through their managed care organization to scheduling a home visit to help them reduce household asthma triggers,” says Link Line’s former director Kathy Lupton. “Sometimes parents just need someone to talk to the school nurse or take the time to explain the difference between their child’s rescue and controller medications.”
By bringing together hospitals, insurers, health and social service providers, and caregivers of children with asthma, the Child Asthma Link Line seeks to improve health status, increase knowledge about asthma triggers and how to manage asthma, and serve as a model for health and social services providers in other cities with similar asthma epidemics. Families referred to the Link Line are not only connected to primary care providers, but also to resources for housing assistance, child development delays, GED training, smoking cessation, lead poisoning prevention and health plan enrollment. The Link Line’s holistic approach to the needs of families and children with asthma helps to ensure that families achieve sustainable improvements in all aspects of their lives. “We have built a relationship with families that goes beyond providing resources,” says asthma counselor Barbara Washington. “We provide moral support. We empower people. The whole program has increased the community’s expectations. Families now see services for children with asthma as a right, rather than as a nice idea.”
A Unique Collaboration
Collaboration between Philadelphia’s three Medicaid managed care organizations has been key to making both the Link Line and Philadelphia Allies successful. Keystone Mercy Health Plan, Health Partners, Inc. and AmeriChoice of Pennsylvania all serve Philadelphia’s needy communities, and had already worked together on other health improvement projects. “We made sure that all of the players were at the table so that we could develop a system that would work within the current system,” says Michael Schaffer, who was director of health outcomes at Health Partners, Inc. during the initial Allies project. “We also wanted to make sure that the program we designed was relevant to potential payers. For us, Allies’ greatest achievements have been its strength in linking patients who present to the emergency department to primary care providers, signing up children for insurance if needed, and making sure that every child has an asthma action plan. Having a neutral convener like Allies available made it possible for us to work together, to break down existing barriers and create a system that I think will work across multiple disease states.”
Between 2002 and 2004, the Link Line served roughly 1,400 families. Initially, nearly 78 percent of all Link Line referrals came from local children’s hospitals, helping to reduce emergency room visits and unnecessary hospital admissions. Within Link Line’s first few years, the number of emergency room visits and hospitalizations reported by participating caregivers was reduced by half, and the percentage of families who reported their children were never absent from school because of asthma tripled.
Standardizing an Asthma Action Plan for Philadelphia—and Pennsylvania
The Link Line uses an asthma action plan developed by Philadelphia Allies in collaboration with three local Medicaid managed care organizations. Widely disseminated in Philadelphia, the Allies asthma action plan is now part of Pennsylvania’s asthma strategic plan and will be distributed to providers, schools and health care systems throughout the state. “The fact that our coalition has become part of state planning is important,” says Michael Rosenthal, M.D., co-chair of Philadelphia Allies. “It’s enabled us to influence the whole system’s approach to treating children with chronic diseases like asthma.”
Reaching More Philadelphia Families
Today, the Asthma Link Line continues to offer a coordinated care strategy that reinforces connections within the community among parents, school nurses, insurers and health care providers. Philadelphia Allies Against Asthma continues to focus its efforts among Philadelphia’s African-American and Latino children. Funding from the Merck Childhood Asthma Network and STEPS, the CDC’s chronic disease prevention program, have enabled the coalition to continue its work. Next steps include working with 16 schools in four different neighborhoods to screen children for asthma and link them to available services. “Asthma is the number one reason for absenteeism in the School District of Philadelphia,” says Link Line’s former director Kathy Lupton. “And we know if we can keep kids in the classroom by managing their asthma symptoms, we can improve the quality of their lives.”
Before his grandmother got help from the Link Line, Lynval’s asthma was out of control. With every attack, Lynval’s father would rush him to the hospital, not knowing where else to turn. His attacks were so severe that he once missed six weeks of school. Link Line staff worked with the family for several months, conducting home visits to teach the family how to manage Lynval’s asthma and reduce triggers such as cat hair and dust. Lynval also attended asthma camp. Today, Lynval plays football and basketball. He has not missed any more school days because of asthma.
PAAA's intervention is a multifaceted, multi agency effort designed to provide care coordination, system support, patient and family education, provider education, public awareness and new policy development. By serving as a forum for discussion of key issues, PAAA works to improve the coordination of a fragmented system of care for children with asthma in Philadelphia.
The Philadelphia Allies Against Asthma Coalition and the Child Asthma Link Line are managed by the Health Promotion Council (HPC). HPC's mission is to promote health and prevent disease, especially among those at greatest risk, through education, outreach and advocacy. The organization has over 25 years experience providing health promotion and disease management services to residents in Southeastern Pennsylvania.
More than 40 organizations, ranging from the city’s three Medicaid MCOs (Health Partners, Inc., AmeriChoice of Pennsylvania and Keystone Mercy Health Plan) to representatives from Philadelphia’s children’s hospitals, departments of health and housing, and neighborhood and community organizations in targeted ZIP codes.
Strategies and Programs
- The Asthma Link Line, a free telephone hotline linking families to asthma care resources
- A common asthma action plan for Philadelphia and Pennsylvania
- Physician Asthma Care Education (PACE) training
- Home visit interventions
- Educational workshops and presentations in the community
Children and Families Served
- Allies focused on reducing asthma-related morbidity in North and West Philadelphia, areas with over 14,000 children with asthma. The coalition's priority area included 14 major neighborhoods in which approximately 75 percent of the population is African-American, 4 percent Asian, and 11 percent Latino; over half of residents live below the poverty line; and a substantial number of children with asthma in the area lack health insurance or a primary care provider.
- Between 2002 and 2004, 1,400 families were referred to the Link Line.
- Tens of thousands of children with asthma in Philadelphia benefit from the introduction of a standardized asthma action plan; the common plan affects hundreds of thousands of children statewide.
- Since its inception in 2002, the Link Line has documented a reduction in emergency department visits, asthma symptoms, missed school and workdays, smoking and anxiety about asthma among families in the program.
- The percentage of families with asthma action plans nearly doubled—from 36 percent to 63 percent.
- The number of emergency department visits and hospitalizations reported by families reduced by half—from 2.9 visits to 1.4 visits per year and from 0.64 to 0.31 hospitalizations per year.
- The percentage of families who reported their child was never absent from school because of asthma increased more than threefold—from 13 percent to 44 percent.
- The average number of work days missed by the family’s caregiver because of their child’s asthma was reduced by half—from nearly three days to less than one day.
- The average number of days in a two-week period that the child reported any asthma symptoms decreased from almost four days to almost two days.
Link Line’s annual budget is $191,000.
- By bringing together all the necessary stakeholders, including competing managed care organizations, Philadelphia Allies created an information clearinghouse as well as a forum for collaboration.
- Significant systems changes such as the common asthma action plan are not possible in cities like Philadelphia without convening coalitions.