Photograph of a multistory medical building with a sign in the foreground reading "Children’s Mercy Adele Hall Campus."
Photograph of a box of environmental measurement equipment on the floor in front of a vanity in a residential bathroom.
Photograph of a man in a residential kitchen measuring the performance of a stove vent.
A woman measures airflow at a living room air vent.
Photograph of a man crouching to examine a furnace in a basement.
Photograph of a man in front of a bedside nightstand handling air-testing equipment.
Photograph of two women seated at a table in an office conferring over documents.

 

Home >Case Studies >Children’s Mercy Kansas City Hospital is Improving Health by Improving Housing

 

Children’s Mercy Kansas City Hospital is Improving Health by Improving Housing

 

Since 1995, Children’s Mercy Kansas City hospital has offered home assessments to identify and, when possible, rectify deleterious conditions in the home environment. After initially focusing on the homes of asthma patients, Children’s Mercy has expanded the scope of its housing-related programming in the greater Kansas City area. Today, the hospital’s Environmental Health Program administers a suite of housing initiatives that ameliorate conditions that can lead to poor health and increased healthcare costs, including the Asthma Friendly Home, Lead Poison Prevention, and Healthy Home initiatives. Crucial to the efficacy of these initiatives are the close working relationships Children’s Mercy has built with local service providers. Partner organizations assist families with mitigation efforts that complement the diagnostic and advisory work of Environmental Health Program staff. The hospital’s involvement in the breadth of health-related housing issues has improved housing conditions and patient health; lowered healthcare costs; and contributed to research, education, and innovation on this topic.

Asthma Triggers in the Home

How Children’s Mercy became so deeply involved in housing issues has to do, in part, with the nature of the hospital’s first target, asthma. The asthma initiative was based on the premise that most people are unaware that certain housing conditions — such as excessive dampness, poor ventilation of cooking appliances, and favorable environments for household pests — can trigger asthma attacks and that mitigating those triggers can have a profound effect on the severity of attacks. Clinicians proposed home assessments as a means of preventing more serious — and more costly — asthmatic episodes. In a pilot program, an environmental hygienist identified specific triggers in a patient’s home and worked with the family to find effective remedies. Quick and dramatic results from the pilot convinced the hospital to fund the assessments as an ongoing initiative. One study of the asthma initiative found reductions of 62 percent in emergency department visits, 86 percent in hospital admissions, and 38 percent in clinic visits among the study’s 25 participants in the year following a home assessment compared with the year preceding the assessment.

A successful asthma management regimen often includes behavioral changes such as smoking cessation and rigorous cleaning. To make the new cleaning behaviors more effective, Children’s Mercy provides most families with a healthy home kit that can include vacuums, mattress encasements, furnace filters, and cleaning supplies. For cases requiring more intensive intervention, such as eliminating mold or a pest infestation, staff can refer families to local commercial services or a community service agency. Some organizations can subsidize mitigation efforts when affordability is a concern.

Going Beyond Asthma

In addition to extending its service area to a radius of 200 miles from Children’s Mercy, the Environmental Health Program has gradually expanded its home assessment services to address other environmental health concerns. In 2001, Children’s Mercy hired its first full-time environmental hygienist, who was tasked with developing a strategy to integrate home visits, patient education, case management, and home interventions and repairs. The following year, a HUD Healthy Homes demonstration grant helped to fund these activities. The Environmental Health Program began its Lead Poison Prevention initiative in 2012 after the Kansas Department of Health and Environment lost its funding for monitoring blood lead levels in children. The lead initiative provides case management and medical consultations, including home assessments to determine the source of the lead exposure, for patients with elevated blood lead levels. The initiative involves staff support from the Environmental Health Program and the expertise and funding of the regional Pediatric Environmental Health Specialty Unit, which is an affiliate of Children’s Mercy Kansas City.

The Healthy Home initiative provides different assessment services to children with complex medical conditions — for example, cancer, cystic fibrosis, transplants, and those with multiple health conditions — for whom environmental exposure may be a concern. The initiative also conducts training classes that have attracted more than 3,000 attendees; 400 community health professionals have been certified as Healthy Home Specialists through the initiative’s courses. The Environmental Health Program also offers community outreach activities and has expanded its environmental assessments to include schools. Every year, the program conducts 8 to 12 building health audits and 12 to 16 school environmental health investigations.

Referral for a home assessment, which is offered to patients regardless of income, can happen in various ways. Any healthcare or social service provider, even those not otherwise affiliated with Children’s Mercy, can refer their clients to any of the environmental health initiatives. Patients can also be referred automatically when their health records indicate a high likelihood that they will need intensive services in the future. The Environmental Health Program’s director, Kevin Kennedy, estimates that only about 20 percent of the families of children with high-risk asthma agree to a home assessment when first asked. Persistent yet sensitive follow-through from Children’s Mercy staff convinces another 20 percent of families to eventually participate. Encouraging the remaining families to participate is a continuing challenge for the Environmental Health Program. The most common obstacles are that families do not understand that the home environment can affect their health or that they are suspicious of a stranger wanting to visit their home.

Future Directions

The Environmental Health Program is developing three additional initiatives that address housing conditions as a social determinant of health. One initiative is a web-based platform that will match families with service organizations according to the environmental needs identified in a home assessment. The platform will automatically notify the most appropriate providers to reach out to the family, placing the responsibility on the provider to take the next step. This initiative will lay the groundwork for more robust sharing of case management in the future. In another new initiative, Children’s Mercy is addressing the inadequacy of the current workforce and financing models for home assessments and mitigation services. Because the efforts of the hospital and community partners cannot meet existing needs, Children’s Mercy is advocating that private health insurance and Medicaid be expanded to cover these services. In addition, Children’s Mercy is developing a geospatial health database to better predict community health risks and facilitate earlier interventions according to identified needs. This effort was supported through a three-year HUD Healthy Homes Technical Studies grant. With these new initiatives and its current environmental health programs, Children’s Mercy Kansas City hospital is improving health care and reducing costs by addressing the housing-related determinants of health.


 

Source:

Felicia Wu and Tim K. Takaro. 2007. “Childhood Asthma and Environmental Interventions,” Environmental Health Perspectives 115:6, 971–5; Interview with Kevin Kennedy, program director, Environmental Health Program, Section of Toxicology and Environmental Health, Children’s Mercy Kansas City, 10 August 2018; Health Research and Educational Trust. 2017. “Social Determinants of Health Series: Housing and the Role of Hospitals.” Accessed 14 August 2018; Documents provided by Kevin Kennedy; Charles S. Barnes, Mercedes Amado, and Jay Portnoy. 2010. “Reduced clinic, emergency room, and hospital utilization after home environmental assessment and case management,” Allergy and Asthma Proceedings 31:4, 317–23.

×

Source:

Charles S. Barnes, Mercedes Amado, and Jay Portnoy. 2010. “Reduced clinic, emergency room, and hospital utilization after home environmental assessment and case management,” Allergy and Asthma Proceedings 31:4, 317–23; Interview with Kevin Kennedy, program director, Environmental Health Program, Section of Toxicology and Environmental Health, Children’s Mercy Kansas City, 10 August 2018; Documents provided by Kevin Kennedy.

×

Source:

Charles S. Barnes, Mercedes Amado, and Jay Portnoy. 2010. “Reduced clinic, emergency room, and hospital utilization after home environmental assessment and case management,” Allergy and Asthma Proceedings 31:4, 317–23; Interview with Kevin Kennedy, program director, Environmental Health Program, Section of Toxicology and Environmental Health, Children’s Mercy Kansas City, 10 August 2018; Felicia Wu and Tim K. Takaro. 2007. “Childhood Asthma and Environmental Interventions,” Environmental Health Perspectives 115:6, 971–5.

×

Source:

Documents provided by Kevin Kennedy, program director, Environmental Health Program, Section of Toxicology and Environmental Health, Children’s Mercy Kansas City; Health Research and Educational Trust. 2017. “Social Determinants of Health Series: Housing and the Role of Hospitals.” Accessed 14 August 2018; U.S. Department of Housing and Urban Development Office of Lead Hazard Control and Healthy Homes. n.d. “Healthy Homes Grantees in Region VII, Great Plains.” Accessed 24 September 2018.

×

Source:

Interview with Kevin Kennedy, program director, Environmental Health Program, Section of Toxicology and Environmental Health, Children’s Mercy Kansas City, 10 August 2018; Documents provided by Kevin Kennedy.

×

Source:

Interview with Kevin Kennedy, 10 August 2018.

×

Source:

Interview with Kevin Kennedy, 10 August 2018; Documents provided by Kevin Kennedy; U.S. Department of Housing and Urban Development Office of Lead Hazard Control and Healthy Homes. n.d. “OLHCHH Lead & Healthy Homes Technical Studies Grants (FY06 – FY17),” 13. Accessed 24 September 2018.

×