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A Marriage of Medicine and Public Health

by Caroline Smart, CloudView Editor

Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic’s best storytelling on America’s population health revolution. To catch up on our series, you can find last week’s story here. Today, we explore how Lowell got doctors and hospitals to work together to fight asthma – overall saving money and getting better outcomes at the same time. 

Today, we explore how Lowell got doctors and hospitals to fight asthma together.

In July 2012, asthma attacks among a group of nearly 200 children in Lowell, Massachusetts plummeted 76 percent compared to the previous year. Emergency room visits for asthma dropped even more. By educating families on the triggers of asthma, providing an intervention plan, and purchasing products families couldn’t afford or had difficulty accessing on their behalf, public health workers were helping Lowell’s children breathe more easily.  As the affected children reported greater health and happiness, the city of Lowell was also discovering monthly healthcare savings of more than $70,000.

The city’s playbook was simple, and replicable: Get doctors and hospitals working together with public-health workers to combat the source, as well as treat the symptoms.

Because asthma is often exacerbated by socioeconomic and environmental conditions, Lowell deployed public health workers to understand conditions in their patients’ communities. The collaboration began with a federally funded program at the University of Massachusetts at Lowell, which empowered community health workers to identify and eliminate environmental triggers such as pest infestations, second-hand smoke, and toxic cleaning products in other affected children’s homes. 

Programs like this one demonstrate why health care can no longer be confined to the hospital or the doctor’s office. Chronic diseases, which account for more than half of all deaths in the U.S. and two-thirds of all health-care spending each year, require treatment plans that begin as close to the source and onset of the disease as possible. That means pivoting to an approach that focuses on a public health as well as medical interventions to achieve better outcomes.

To facilitate the exchange of information between medical and public health practitioners, as well as to solicit other perspectives on the city’s health issues, an independent nonprofit called the Greater Lowell Health Alliance was founded in 2006. The GLHA convened hospital executives, public health officials, community physicians, the city manager, school superintendent, and others to discuss the public health needs of the community.  Since then, the GLHA has taken the lead on Lowell’s triennial Community Health Needs Assessment (CHNA), which addresses the health-care system’s strengths and weaknesses. These reports, mandated by the Affordable Care Act, cover both medical and public-health perspectives, in effect enforcing that collaboration. 

In a state that has among the nation’s highest incidence of asthma, Lowell’s approach has inspired similar initiatives elsewhere. In Boston, as hospital admissions for asthma rose across the city, the Public Health Commission founded the Boston Asthma Home Visitation Collaborative to better connect the city’s hospitals with community health workers.

The organization created a centralized referral center that connects residents with health workers in their communities and began conducting monthly visits to asthma patients’ homes. It also made sure that clinical data was shared shared with relevant community health workers and that environmental health data reached the right doctors.  The program cut asthma-related emergency department visits by more than half, and at Boston Children’s Hospital it achieved $1.46 in savings for every dollar invested. Last year, the Massachusetts Department of Health funded implementation of the home visitation program statewide, including in Lowell.

Lowell’s holistic approach integrating medial treatment with environmental interventions and education performed across the city, has undoubtedly made an impact across Massachusetts.

Tune next week as Population Health(ier) travels across the country to a small, rural American city where population health was born.

To experience an interactive feature along with access to the full Population Healthier series, visit The Atlantic.


Caroline Smart is a Senior PR Associate and CloudView Editor.

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