- When it comes to effective chronic disease management, healthcare providers and medical researchers may need to refocus their efforts on how quality care can extend beyond the hospital walls, especially for racial minorities and socioeconomically challenged populations.
A recent press release from the Harris Health System reported some success with personalized home-based interventions for African American asthma suffers around Houston.
Participants in the study received a home assessment that evaluates environmental triggers for asthma attacks. With the results of the assessment, researchers developed tools to reduce exposure to specific triggers and created an individualized self-management program for the patient.
“We find time and again that patients who have had asthma for more than 20 years didn’t realize certain types of exposures, such as fragrances, affect their condition,” said Winifred Hamilton, PhD, researcher at Harris Health System and Baylor College of Medicine professor.
“Sometimes, for example, a study participant will tell us that perfume is a major trigger for them, and then we visit their home and find that every room in the house has a plug-in deodorizer in an outlet spewing chemicals and fragrance into the home. We can help them make the connection and work together to find safer alternatives.”
Harris Health Systems, in collaboration with Baylor College of Medicine, intends to identify better chronic disease management strategies that address the significant gaps in quality care for African American patients with asthma.
African American adults only account for about 19 percent of the population in Houston, but almost 34 percent of asthma-related hospital admissions are African American individuals. While millions of Americans have asthma, African American individuals with the chronic disease are three times more likely to die from an attack.
Another similar study has found that home interventions are effective management strategies for all asthma patients. For every dollar spent on home intervention tools for asthma management, patients and providers save about $5 to $14 in healthcare costs or productivity losses.
The press release detailed one patient’s success with the study so far. As part of her personalized treatment plan, the participant discovered what environmental factors trigger an asthma reaction and how she can prevent adverse events.
By using the management plan, the participant was able to reduce her emergency department utilization significantly. Instead of visiting the ED up to five times a week, the patient reported that adhering to simple self-management strategies means she rarely has to go to the hospital because of asthma attacks anymore.
Other participants have also claimed that the study has helped them to self-manage their chronic condition and return to a more active lifestyle.
The study is continuing into its third year and final results have not been published yet. Researchers are currently recruiting new participants in the Houston area.
In order to establish comprehensive and effective chronic disease management programs, healthcare providers may need to review more environmental and lifestyle information, which substantially contribute to the success of patient-centered care.
“Health primarily happens outside the doctor’s office—playing out in the arenas where we live, learn, work and play,” said Karen DeSalvo, MD, MPH, MSc, National Coordinator for Health Information Technology in December 2014. “In fact, a minority of our overall health is the result of the health care we receive.”
This has been especially true for asthma patients because environmental and lifestyle factors can easily set off an attack. For example, participants in the Houston-based study learn that the city’s air quality as well as its heat and humidity levels are major triggers for attacks.
Unfortunately, providers typically do not have access to socioeconomic or lifestyle data as part of their clinical care routine. Without this information, researchers have noticed that care disparities are growing, especially for racial minorities and lower socioeconomic populations.
It is key that providers gain access to social and economic information in order to determine how social determinants, such as housing status, lack of transportation, or limited access to healthy foods, impact patient outcomes.
Through the CMS innovation center, researchers are currently working to create methods for conveniently collecting social determinant information and putting that data into the hands of providers.
For example, the Accountable Health Communities model requires physicians to identify health-related social needs for patients and partner with the community to coordinate services, such as transportation.
“We want local providers to understand the issues facing their service areas, and we want to give them the opportunity to drill down into some of the factors related to their work that may need improvement,” said Cara V. James, PhD, Director of the CMS Office of Minority Health, to HealthITAnalytics.com in a previous interview.
“As we continue to link socioeconomic factors to clinical care, we will be able to rethink how to address these relationships, and I believe that will help us make a meaningful impact on metrics like readmission rates or medication adherence.”