State awards Boston Innovation Grant to address preventable health conditions

Mayor Martin J. Walsh today announced the Massachusetts Department of Public Health has awarded the Boston Public Health Commission (BPHC) nearly $250,000 through the Commonwealth’s Prevention Wellness Trust Fund to implement the first phase of a partnership to reduce health care costs through prevention and improved chronic disease care. The BPHC and a host of partners, including community health centers, the Boston Public Schools, child care facilities, and the city’s Commission on Elderly Affairs, will collaborate on a project to address hypertension, pediatric asthma, and elder falls in Roxbury and North Dorchester, where residents are burdened by some of the state’s most substantial health inequities. Boston is one of nine award recipients statewide.

“This grant will allow us to focus on the neighborhoods where our residents are most impacted by health inequities, and leverage our network of community health centers to provide better access and proactive care,” Mayor Walsh said. “At the same time, we’re looking ahead to establishing best practices that can be expanded to every neighborhood in the city of Boston.”

The first phase of the project involves a six-month capacity building effort by the partners. After demonstrating readiness to implement interventions in community and clinical settings, the BPHC and its partners will receive an additional $900,000 to $1.5 million for each of the next three years to carry out the interventions.

“As a lifelong asthmatic I know firsthand the importance of what this grant will allow us to accomplish,” said Felix Arroyo, Chief of Health and Human Services for the City of Boston. “Not only will we be able to reduce health care costs, we'll be working towards chronic disease prevention and improving chronic disease care.”

Black, Latino, and low-income residents who face disproportionately high burdens of asthma and hypertension and elders of all races and ethnicities who face a high risk of falls are the target populations. Black and Latino residents make up 65% of the population in Roxbury and North Dorchester, where between a quarter and a third of families live below the poverty level.

“We are deeply honored to receive this award, which gives us a unique opportunity to work with an accomplished group of committed partners to reduce major health inequities that affect our neighborhoods,” said BPHC Executive Director Dr. Barbara Ferrer. “Our team is organized to help residents overcome the economic, cultural, and linguistic barriers that have historically limited their access to clinical and community-based services.”

The rate of pediatric asthma emergency department visits and hospitalizations in the two neighborhoods is substantially higher than city- and state-wide rates. Similarly, residents of both neighborhoods, where obesity rates surpass those of Boston as a whole, are approximately 30% more likely to suffer from hypertension. The prevalence of smoking, which contributes to asthma and hypertension, is higher in these areas than Boston overall. The project area is also home to over 12,000 seniors, an age group that accounted for 84% of fall-related deaths in Massachusetts in 2010.

Led by the BPHC’s Medical Director Dr. Huy Nguyen, the project will take a population health management approach to creating interventions that address hypertension, pediatric asthma, and elder falls in an integrated way across all of the provider organizations involved in the initiative. Dr. Nguyen is a practicing pediatrician at Dorchester House Multi-Service Center, one of eight community health centers participating in the project.  The others are Bowdoin Street, Codman Square, Geiger Gibson, Neponset, Harvard Street, Upham’s Corner, and Whittier Street.

The project plan calls for health centers and community partners to utilize evidence-based practices that help patients better manage their health; to strengthen mutual referral and service relationships to identify, track, and better serve at-risk individuals; and to build, test, and refine sustainable clinical-community linkages to reduce health inequities. Every health center serving Roxbury and North Dorchester is a partner on the project, and each center will address all three health conditions. The neighborhoods’ shared community assets and network of providers, residents, and existing prevention and wellness initiatives will be leveraged to address common health challenges and inequities that impact the communities.

Pediatric asthma work will focus on improving care for high risk patients by providing smoking cessation tools and by integrating asthma management across clinical, day care, school, and home settings. Expanded care teams that include area pharmacists and community health workers will engage hypertensive patients to improve their blood pressure. To strengthen fall prevention efforts, providers will identify at-risk seniors through an assessment process and connect them to balance and mobility programs as well as services to improve the safety of their homes.

The working group hopes Roxbury and North Dorchester, with a combined population of 140,000 residents, will serve as a proving ground for strategies that could be expanded citywide in the future. Planners will look at ways in which the interventions and lessons learned can be shared with the broader community by engaging hospitals and health centers outside of the project area, for example, in developing and disseminating successful strategies.