Reduced clinic, emergency room, and hospital utilization after home environmental assessment and case management

Abstract

Allergists often suspect home environmental conditions are contributors to allergic disease. Case management can be an effective tool in managing asthmatic patients. To describe the impact of home environmental assessments and case management on the medical care utilization of patients with allergic disease the following studies were conducted. This study was designed to retrospectively examine health care utilization of pediatric patients that had a home environmental assessment recommended by a pediatric allergist as part of a comprehensive case management program. Subjects were chosen from pediatric patients who received home assessment after referral for case management by pediatric allergy specialists in a hospital-based clinic as indicated by high emergency room (ER) and hospital utilization. Case management included education, clinic visits, environmental assessment, and a single person responsible for following the subject's care. Home assessment included airborne spore collections, surface collections, and dust collection for evaluation of antigens. There were 25 subjects. Seventy-two percent were asthmatic and 12% were diagnosed with allergic rhinitis. In the year before entering the study these subjects experienced 47 ER visits, 22 hospitalizations, and 279 clinic visits. In the subsequent year they underwent 18 ER visits, 3 hospitalizations, and 172 clinic visits. Penicillium/Aspergillus levels were above 100 spores/m(3) of air in 94% of homes and above 1000 spores/m(3) in 74% of homes. Thirty-six percent of homes had Stachybotrys above 100 spores/m(3). Home environmental assessment and case management may reduce medical care utilization for children suffering from allergic rhinitis and asthma.

Alleviation of Retching and Feeding Intolerance After Fundoplication

“…In this way, environmental allergens can increase work of breathing, postnasal drip, and secretion mishandling, thereby exacerbating the tendency to retch. Of the environmental allergens, one of the most notorious is mold 36 – 39 ; in one representative case in this series, new retching manifested after a family moved into a rental house with well‐known water damage. Household testing confirmed a heavy mold problem, and the child's retching and dyspnea resolved only after the family found new housing.…”

Heterodox Microeconomics: A Spatial Turn for Environmental Health and Just Food System Social Provisioning

“…Instead, food allergy clusters reveal the need to investigate structural inadequacies in food's social provisioning related to the patient's environment. Therefore, these findings afford practitioners the opportunity to explore alternative treatment strategies, such as upstream medicine (Barnes, Amado, & Portnoy, 2010;Manchanda, 2014), as well as preventive medicine (Wilson et al, 2019). Additionally, with this information the community becomes empowered to implement strategies to transform their environments and engage in democratic activities to alter the social provisioning process.…”

“…At first glance, it might appear as though this type of value system is too abstract to be effective. However, the measures provided by Chetty's team above, reductions found in exacerbated asthma outcomes (Barnes et al, 2010), improvements to microbiome health (Rivas et al, 2013) increases to green space (Wolch, Bryne, & Newell, 2014), carbon footprint calculators e.g. carbonfoodprint.com, and a multitude of other measurables are already included in grant research and social enterprise performance plans and annual reports.…”

Nurses and the Social Determinants of Health

“…If a child lives in a home contaminated with mold, no amount of asthma medication will decrease their symptoms. However, if home remediation is done there will be dramatic improvement in the child's disease as evidenced by a decrease in symptoms as well as emergency department visits (Barnes, Amado, & Portnoy, ).…”