An Evaluation of a State-Funded Healthy Homes Intervention on Asthma Outcomes in Adults and Children

Project Funder: U.S. Department of Housing and Urban Development (HUD)

Project Partner: The New York State Department of Health

Project Contact: Amanda Reddy, areddy@nchh.org, 443.539.4152

Project Description: Evidence suggests that a comprehensive healthy homes approach may be an effective strategy for improving housing hazards that affect health, but questions remain about the feasibility of large-scale implementation. From 2008 to 2012, the U.S. Department of Housing and Urban Development (HUD) funded a study to evaluate the impact of a large-scale, multisite, state-funded healthy homes program. The New York State Healthy Neighborhoods Program (NYS HNP) is distinct from previously evaluated programs in its scale, geographic scope, and funding structure. Although the program is nearly 30 years old, the evaluation focused on a five-year period after the implementation of a standardized data collection instrument. This unique data set included information about services provided to more than 29,000 homes with 82,000 residents in 13 counties across the state of New York.

The NYS HNP operates in select communities with a higher burden of housing-related illness and associated risk factors. Since reducing exposure to environmental triggers is a critical part of asthma management, the objective of this study was to evaluate the impact of a healthy homes intervention on asthma outcomes for adults and children and assess the impact of different targeting strategies.

For this evaluation, the NYS HNP provided visual assessments and low-cost interventions to identify and address asthma triggers and trigger-promoting conditions in the home environment to 1,465 residents with asthma. The conditions were reassessed during a revisit conducted three to six months after the initial visit. The participants were recruited using three mechanisms: door-to-door canvassing (a “Canvassed” group), resulting in 752 residents recruited from 457 dwellings; referrals from community partners (a “Referred” group), resulting in 573 residents from 307 dwellings; and via referrals of Medicaid enrollees with poorly controlled asthma (a “Targeted” group), which yielded 140 residents from 140 dwellings.

The analysis compared improvements across the three groups for measures of asthma self-management, healthcare access, morbidity, and environmental conditions. An asthma trigger score characterizing the extent of multiple triggers in a dwelling was also calculated.

The analysts noted significant improvements among the 1,465 adults and children evaluated in environmental conditions and self-reported self-management, healthcare access, and asthma morbidity outcomes for each group. The Targeted group showed the greatest improvement for most outcomes, but selected measures of self-management and healthcare access were greater in the other groups. The mean improvement was significantly greater in the Targeted group.

The study determined that targeting the intervention to people with poorly controlled asthma maximizes improvements in trigger avoidance and asthma morbidity; however, other recruitment strategies are effective for impacting endpoints related to healthcare access and self-management. Healthcare payers, state and local health departments, and others should consider investing in these home-based services as part of a comprehensive asthma care package.

Resources

Reddy, A. L., Gomez, M., & Dixon, S. L. (2017, March-April). An evaluation of a state-funded healthy homes intervention on asthma outcomes in adults and children. Journal of Public Health Management and Practice, 23(2), 219-228.

Digital Supplement 1: NYSDOH Healthy Neighborhoods Program and Asthma Forms [pdf] Digital Supplement 2: Prevalence of and Improvement in Asthma Triggers and Trigger Promoting Conditions, by Recruitment Group [pdf]

Related Studies

In a series of three peer-reviewed articles, we presented findings from a retrospective evaluation of this large-scale, multisite, state-funded healthy homes initiative. These are the other two projects related to this evaluation:

The New York State Healthy Neighborhoods Program: Findings from an Evaluation of a Large-Scale, Multisite, State-Funded Healthy Homes Program [url]

A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents with Asthma: Findings from the New York State Healthy Neighborhoods Program [url]