Uncovering geographic clusters, or "hot-spots," of child asthma helps medical providers understand patient needs and radically improves treatment. All child asthma data was provided by Mercy Children's Pulmonary Center and the research was made possible through collaboration with ABLE.

Process

Mercy's Pulmonary Center sends ABLE data containing the addresses of patients. The addresses are de-identified by rounding up or down to the nearest block making the precise location impossible to determine. ABLE then maps this information and the team reviews the results to help guide programs and services, and inform advocacy for policy change. The research team consists of:

      Dawn Bolyard, R.N.
      Dr. Reddy, M.D.
      George Thomas, J.D.
      Nancy Buderer, M.S.

This study was approved by the Mercy St. Vincent Pediatric Institutional Review Board.

Asthma and Housing Conditions

ABLE has mapped the location of more than five hundred children suffering from asthma, and the team has identified asthma hot-spots.

Based on the mapping process and the experiences of both ABLE and Mercy's Pulmonary Center, the team believes that many of the issues creating child asthma clusters are a result of poor housing conditions, including mold and cockroaches.

Home Nursing Services

Now that initial research is complete and hot spots are identified, Mercy has begun a new program to send nurses to patient homes. The nurse identifies environmental issues in the home that could trigger asthma including mold. More information on the program is available under the "media" tab.

Legal Services

In some cases, housing conditions that trigger asthma result from landlords' failure to maintain rental units. Under Ohio law, landlords must maintain rental units in fit and habitable condition. This includes repairing issues that cause poor indoor air quality. Many landlords will respond appropriately to a request for repairs from a tenant or a nurse who visits the home. When they do not, the medical provider makes a referral to ABLE for legal services to assist the tenant. Tenants who live in federally subsidized housing have additional rights.

Targeting Services to Hot-Spots

When implementing both the home nursing program and legal services, the team uses the data and maps to target limited resources to hot-spots. The medical providers use the data and maps when assigning nurses to visit homes, referrals to ABLE are similarly targeted.

Investing in Healthier Housing

With passage of the Affordable Care Act (ACA), non-profit hospitals must conduct a Community Health Needs Assessment (CHNA) and implement efforts to improve the health of residents in the neighborhoods they serve. These programs should address housing conditions that cause health issues.

In addition, the IRS requires 501(c)3 hospitals to file a tax return that reports information about each hospital's activities to improve the health of the communities they serve. Schedule H of the return covers community building activities that could include improvement of housing conditions in asthma hot-spots.



With an improved understanding of asthma hot-spots, the Toledo and Lucas County community has an opportunity to invest in programs and services designed to improve housing conditions. Moving forward, ABLE will advocate that the impact of substandard housing should be included in the CHNA and programs designed to improve community health.

Documentation

All asthma data was provided by Mercy Children's Pulmonary Center. Asthma data has not been provided from any other sources yet.

Sources for demographic data:

• U.S. Census, American Community Survey.
• The Lucas County Land Bank's Toledo Survey
• The City of Toledo's Department of Code Enforcement

Minority Health

Asthma clusters are often located in low-income and African American neighborhoods.

More information on asthma as a minority health issue in Ohio:

• Childhood Asthma in Ohio
• Asthma Disparities
• CDC Asthma Profile for Ohio

Additional References

• Beck AF, Huang B, Chundur R, Kahn RS. Housing Code Violation Density Associated With Emergency Department And Hospital Use By Children With Asthma. Health affairs (Project Hope). 2014;33(11):1993-2002. doi:10.1377/hlthaff.2014.0496.


• Beck AF, Moncrief T, Huang B, et al. Inequalities in Neighborhood Child Asthma Admission Rates and Underlying Community Characteristics in One US County. The Journal of pediatrics. 2013;163(2):574-580.e1. doi:10.1016/j.jpeds.2013.01.064.


• Clift K, Scott L, Johnson M, Gonzalez C. Leveraging Geographic Information Systems in an Integrated Health Care Delivery Organization. The Permanente Journal. 2014;18(2):71-75. doi:10.7812/TPP/13-097.


• Hardt NS, Muhamed S, Das R, Estrella R, Roth J. Neighborhood-Level Hot Spot Maps to Inform Delivery of Primary Care and Allocation of Social Resources. The Permanente Journal. 2013;17(1):4-9. doi:10.7812/TPP/12-090.


• Hood E. Dwelling Disparities: How Poor Housing Leads to Poor Health. Environmental Health Perspectives. 2005;113(5):A310-A317.


• Krieger J, Higgins DL. Housing and Health: Time Again for Public Health Action. American Journal of Public Health. 2002;92(5):758-768.


• Pearlman DN, Zierler S, Meersman S, Kim HK, Viner-Brown SI, Caron C. Race disparities in childhood asthma: does where you live matter? Journal of the National Medical Association. 2006;98(2):239-247.