Why Provide Asthma Home Visiting?

Asthma is common and costly

Asthma is a common, chronic lung condition characterized by ongoing airway inflammation associated with increased airway responsiveness to a variety of triggers. In Wisconsin, approximately 582,000 adults and children are living with asthma. Asthma is a complex condition that requires a multifaceted approach to effective management at both the individual and population levels. Comprehensive asthma care includes a seamless alignment of the full array of services across the public health and health care continuum.

The burden of asthma is not equally shared across Wisconsin. Certain age groups, gender, racial and ethnic minorities, geographic regions and socioeconomic groups are disproportionately affected, P-01727 (PDF). Systemic racism as well as many social, economic and environmental factors (social determinants of health) create an undue burden on populations of color compared to white populations. These social determinants of health include, but are not limited to: racism, sexism, poverty, stress, access to healthy housing, access to health care, and exposure to indoor and outdoor pollutants. Recent data show significant disparities in asthma burden among Black, Indigenous and Hispanic populations, and among children younger than 5 years of age. Learn more facts about asthma including asthma prevalence and rates of asthma-related emergency department visits and hospitalizations.

Asthma home visiting provides many benefits

Home visits provide an opportunity to educate patients, families, and caregivers about asthma to help them better manage the disease. Providing these services in a home setting can be very effective as it builds trust by meeting people where they are. It also provides the opportunity to evaluate the home environment where the patient spends much of their time and identify asthma triggers present in the home that might be contributing to worsening asthma symptoms.

The following are some of the benefits of asthma home visiting.

Improved asthma outcomes

Asthma home visiting has been shown to improve asthma control and reduce unplanned health care utilization related to asthma. Participants of the Asthma-Safe Homes Program report improved Asthma Control Test (ACT) scores, fewer asthma-related ED, hospital, and urgent care visits, and fewer missed school and workdays due to asthma exacerbations after completing the program. Eighty percent (80%) of participants had an improved ACT score and 39% moved from uncontrolled to well-controlled upon completion of the intervention. These improvements led to a 76% decrease in urgent care visits, 21% decrease in ED visits, 50% decrease in hospitalizations, and 33% decrease in missed school and workdays. Since asthma home visiting focuses on those with the most poorly controlled asthma and addresses barriers to care for populations disproportionately affected by asthma, this intervention can also reduce disparities in asthma outcomes.

Cost savings

Health plans can save on costs when rates of hospitalizations and ED visits decrease. An analysis of Wisconsin Medicaid claims for Asthma-Safe Homes Program participants showed a return on investment of $1.30 for every dollar spent. Plans may see an even greater savings when providing services to the subset of patients with the highest number of ED visits or hospitalizations (high utilizers). Patients also benefit financially by missing fewer workdays and spending less on costly emergency care.

Performance and quality improvement

Asthma home visiting services can also contribute to the improvement of asthma-related performance and quality measures that health plans and health organizations may monitor, such as the Health care Effectiveness Data and Information Set (HEDIS) measures: Asthma Medication Ratio (AMR), which assesses whether patients are receiving the optimal ratio of controller medications to total asthma medications; and Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) which assesses the percentage of patients with an urgent care visit, hospitalization, or ED visit for asthma that had a corresponding follow-up visit within 30 days. Alternative performance and quality measures could include asthma-related ED or inpatient admission rates. During home visits, asthma educators reinforce the importance of patients following their treatment plans. They can also help patients identify and address barriers to medication adherence, which in turn can lead to improved quality measures mentioned above.

Improved patient satisfaction

Beyond improving the health of the patients and reducing costs, providing client-centered services like asthma home visiting can improve patient satisfaction with the services health plans and health care organizations provide.

Here are a few testimonials Asthma-Safe Homes Program participants have shared after participating in the program.

I recommend anyone with asthma to utilize the program. It's very helpful and the educator was very professional and pleasant.

I was impressed with the quick response from the [educator]. I'm very grateful for the assistance I received.

The [program] helped my family tremendously. I wish I knew about this program sooner.