Answers provided by Amy Miller, Executive Director

1) What is the name of the asthma mobile program in your city?

We call our mobile clinics the Asthma Van and Asthma Van II

2) When was it established?

We were incorporated in 1998 and began seeing patients in November of 1999.

3) How and why was it established?

The Mobile C.A.R.E. Foundation began with the vision and volunteer efforts of four Chicago area physicians (Philip Sheridan, Sr., MD; Philip Sheridan, Jr., MD, MBA, Paul Detjen, MD, and Eric Gluck, MD) to combat the growing asthma epidemic in Chicago. It is now known that Chicago has one of the highest prevalence rates and highest death rates for asthma in the entire country. In Chicago, asthma is the number one reason for school absenteeism, number one reason for ER visits, and a leading cause of hospitalizations for children.

The original business plan was developed in May 1997. The plan outlined the Comprehensive Asthma Management Program, a program that would provide free, standard medical care and health education for thousands of children living with asthma in underserved communities via mobile medical clinics that were conveniently located at inner-city schools. A mobile delivery model was chosen because it offers low-income families, with limited transportation and time, an accessible and efficient option for receiving medical treatment. School delivery sites were selected because the local school is the hub of all community activities and provides the most consistent access to children for patient identification and follow-up. The school-based mobile asthma clinic would streamline the convoluted process of connecting children from needy families with preventive and continuous health care. Mobile C.A.R.E. would bring the doctor to the patient.

Mobile C.A.R.E. was recognized as an incorporated, non-profit organization in January 1998. The newly formed Mobile C.A.R.E. Board of Directors visited Craig Jones, MD, a pediatric allergist at University of Southern California. Dr. Jones launched a mobile asthma clinic program based on the urban asthma problem in Los Angeles. In early 1999, Mobile C.A.R.E. received a contribution to serve as seed money to put the model into operation. In six months, a mobile clinic was purchased and outfitted, a medical team was hired and a contract for service at five Chicago Public schools was signed. On November 1, 1999, Mobile C.A.R.E. launched the Chicagoland Breathmobile at Riis Elementary School on Chicago’s West side. Operating on a part-time basis, the Breathmobile enrolled 35 patients and conducted 42 medical visits at Riis and Pablo Casals Elementary School in only four weeks. This was the start of an explosive year for patient enrollment and organizational growth. Throughout the next three years, Mobile C.A.R.E. expanded the Chicago Public School contract to allow for 100 schools. The clinics began service throughout the Chicago Archdiocesan schools as well. A second mobile clinic, the Asthma Van, was launched into service in 2002. In 2004, the mobile asthma clinics began to make stops at Head Start sites in addition to schools to emphasize the importance of early identification and intervention.

4) Who is served by the program?

Each year Mobile C.A.R.E. serves over 1,200 children and their families during more than 3,000 visits to the mobile clinics. The patients range from age six months to 18 years old, with the average patient age being just under nine years old. About 52% of families carry public aid health benefits through Medicaid and KidCare (Illinois’ State Children’s Health Insurance Plan), 11% are uninsured, and 37% have some type of private insurance, but are underinsured (high deductible, no prescription coverage, and the like). Approximately 38% of our current patients are African-American, 58% are Hispanic and 4% are Caucasian or other. Fifty-two percent of our patients are male and 48% are female.

Mobile C.A.R.E. serves public schools, parochial schools, and Head Start sites in 23 community areas across primarily the West and South sides of Chicago. These communities have an average income of only of 49% of the area median family income. Over 35% of the children in these community areas live in poverty, as compared to only 23% of children in Chicago as a whole, and 18% of children nationally. All of the school sites Mobile C.A.R.E. serves are those where 50% or greater of the students are on the free or reduced lunch fare program. Families in the communities served also face many other hardships. The 2001 teenage pregnancy rate in these community areas was 41% greater than Chicago as a whole. Their infant mortality rate (IMR) in 2001 was 14% greater than Chicago’s IMR, and the number of violent crimes per square mile in 2002 was 64% greater than the overall City violent crime index.

5) How does the mobile program work in your city -- where does it go and when, and how does your team publicize the routes?

We diagnose and provide follow up medical care as related to asthma; physical check ups on ears, throat, lungs, etc.; spirometry; environmental allergen skin testing; peak flow readings; one-on-one education on asthma, asthma management, triggers, medications, and medication utilization. We specialize in asthma and allergies, but our physicians are pediatricians who often identify illnesses and conditions other than asthma. We treat what we have the capability on the vans to treat (i.e. ear infections, eczema, and the like), but for anything outside our scope, we refer our patients to a specialist or a primary care physician depending on what the situation dictates.

We stop at 43 different public schools, parochial schools, and Head Start sites on a rotating, monthly schedule. To publicize routes, we have a monthly distribution listserv which we send our calendar out to. This list includes personnel from the 43 various sites where we stop, Board members, donors, community activists, other asthma and primary care programs around the city, and the American Lung Association, among many other organizations and individuals. However, we do not rely solely on this method of distribution to fill our appointment schedule. In fact, we have a full time Patient Scheduler that calls all new and existing patients to schedule all of our appointments. We have lists of students from each of the 43 sites (and surrounding communities), we call them "trackers," where we keep track of when patients were seen and when they are due back according to the doctor's instructions. To fill in around the kids that are due back, we schedule new appointments.

6) How do parents and kids find out about the services offered?

The majority of our patients are present and former students (or siblings of students) of the schools that we visit (or have visited in the past). They find out about our services through a respiratory health survey that the school helps us implement before our initial visit in order to identify the children who need our services. However, we do not turn any families away, so if anyone else sees our Asthma Vans or hears about us through word of mouth and is interested in our services, they are welcome to call and make an appointment at the location most convenient for them.

7) How are the services funded?

The majority of funding comes from private donations and grants from Foundations, Corporations, and Individuals (85% in 2004). A small portion is grants from local and federal government agencies (11% in 2004). An even smaller portion comes from reimbursement for care provided to children on Medicaid (4% in 2004).

8) What gaps does this program fill in your city?

Asthma can be controlled by compliance with an established regimen of medication, trigger (or allergen) avoidance, and regular medical care. Unfortunately it is particularly difficult to access/afford continuous and appropriate health care in underserved, minority communities such as those in inner-city Chicago. Thus, Mobile C.A.R.E. provides such accessible, affordable, and effective services. Mobile C.A.R.E. does not pull children from existing, successful medical treatment. Rather, the service provided at the mobile clinics is focused on children who are not receiving appropriate, preventive, and follow-up asthma care.

9) How many kids are served by your program?

On average, each of our mobile clinics sees 10-15 patients per day, for a total of 20-30 families per day. During the year, our mobile clinics will serve about 1,200 families at over 3,000 visits. Since inception, we have seen nearly 3,000 families at over 10,000 visits.

10) Over the last 10 years, how has the asthma rate changed for children in your area?

Unfortunately in Chicago, the asthma rates have yet to drop. There are numerous studies happening right now to discover the reasons why. However, we have been able to make great progress amongst the children that are cared for on the Asthma Vans.

11) How is your program affecting the kids you serve?

A formal analysis by a third party consultant on data collected from November 1999 through November 2004 showed that the Comprehensive Asthma Management Program is a huge success. Mobile C.A.R.E. significantly decreased resource utilization, asthma symptoms, missed school and work days, and home environmental triggers. The number of emergency department visits per patient per month decreased by 62% and the number of days of hospitalization per patient per month by 71%, after five visits to the mobile clinic. Likewise, the number of patients reporting any visits to the Intensive Care Unit for asthma decreased by 89% after just four visits to the mobile clinic.

Likewise, debilitating and disruptive symptoms such as daytime and nighttime coughing, wheezing, dyspnea (shortness of breath), and rescue b-agonist use all decreased by a statistically significant amount in Mobile C.A.R.E. patients after five visits to the Asthma Vans. Meanwhile, lung function measured by PEFR, or Peak Expiratory Flow Rate, significantly improved. These symptom improvements are also reflected in number of school absences due to asthma; the number of patients reporting missed school days decreased by 60% after just four visits. Parents missing workdays due to their child’s uncontrolled asthma is another major issue ameliorated by Mobile C.A.R.E.’s services. The number of work days missed per parent per month decreased by 73% after four clinic visits.

Mobile C.A.R.E.’s Comprehensive Asthma Management Program also demonstrated statistically significant decreases in environmental triggers reported by patients and families in their homes. Rodents, roaches, and mold were all decreased in the home setting, thereby reducing the probability that a child will be exposed to one of these triggers and suffer from an acute exacerbation. In addition, Mobile C.A.R.E. worked diligently with families to reduce patients’ exposure to second hand smoke. Second hand smoke has been proven to worsen asthma and may even be the cause of some cases of asthma. Smokers quit in close to 20 percent of patients’ homes over the process of five Asthma Van visits.