An evaluation of the asthma intervention of the New York State Healthy Neighborhoods Program.

BACKGROUND

The Healthy Neighborhoods Programs (HNP) are funded by the Federal Preventive Health and Health Services block grants and administered by the New State Department of Health (NYSDOH). Eight county and local health departments are funded for 3 years for a total of $1.25 million per year to target households at risk for environmental health and safety hazards. The HNP asthma intervention uses home visits to identify asthmatics, assess asthma morbidity and management, and identify environmental asthma triggers. Outreach workers provide education about asthma, referrals, and controls for asthma triggers. The purpose of this evaluation was to assess the impact of the HNP asthma intervention for the 1997-1999 funding cycle and for the first year of the 2000-2002 funding cycle. Because of changes in reporting requirements across the funding cycles, the findings for 1997-1999 and 2000 were analyzed separately.

METHODS

We analyzed one final outcome measure, the rate of self-reported hospitalizations (admissions and emergency room visits), and three intermediate outcome measures (the percent of homes with cockroaches, the percent of asthmatics with a written management plan, and the percent of asthmatics using a peak flow meter). We also estimated the net savings resulting from a reduction in hospital admissions due to asthma.

RESULTS

For the 1997-1999 funding cycle, the average hospitalization rate was 86 hospitalizations per 100 asthmatics per year at the intervention visit (i.e., the baseline rate) and 44.5 at the 1-year follow-up, a decrease of 48%. This was a larger decrease than the 24% average annual decrease in the baseline rates during the 3 years. In 2000, there were 96 hospitalizations per 100 asthmatics per year at the intervention visit and 25 at the one-year follow-up, a decrease of 74%. In 2000 there were about 110 fewer hospital admissions thought to be due to the net effects of the HNP intervention, resulting in an estimated gross savings of $905,300 (110 x $8,230). After subtracting the estimated cost of the asthma intervention ($624,683), the net savings were $280,617.

CONCLUSION

New York's HNP seems to be succeeding in reducing asthma morbidity as measured by the hospitalization rates among asthmatics who have received the intervention. The HNP was successful in decreasing cockroach infestation in HNP homes. A standardized evaluation methodology and instrument are necessary to conduct a more rigorous evaluation of the HNP.