58 - Co-Design and Pilot Feasibility Trial of a Multi-Level Asthma Advocacy Pathway and Home Visiting Intervention: BREATHE (Building Resilience, Education, and Training for Health and Environment)

Publication Number: 3055.58

Julia Rosenberg, Yale University, New Haven, CT, United States; Laura Chen, Yale School of Medicine, New Haven, CT, United States; Brendalis Altamirano, Hispanic Federation, Hamden, CT, United States; Lori Powers, Yale-New Haven Children's Hospital, Old Saybrook, CT, United States; Magaly Cajigas, Hispanic Federation - Connecticut office, Hartford, CT, United States; Carlin F. Aloe, Yale School of Medicine, New Haven, CT, United States; Shannon O'Malley, Yale School of Medicine, New Haven, CT, United States; Sarah Mervine, Center for Children's Advocacy, Hartford, CT, United States; Sherin Panacherry, Yale School of Medicine, New Haven, CT, United States; Rose Banks, Yale New Haven Hospital, New Haven, CT, United States; Kely I. Pimentel Duran, Hispanic Federation, Storrs, CT 06268-2507, CT, United States; Mona Sharifi, Yale School of Medicine, New Haven, CT, United States; Ada M. Fenick, Yale University, New Haven, CT, United States; Sandra Zaeh, Yale School of Medicine, New Haven, CT, United States; Julie Flom, Yale School of Medicine, New Haven, CT, United States

Background: Children living in New Haven, Connecticut have the highest rate of asthma-related morbidity in the state.

Objective: To co-design and assess the feasibility and acceptability of a multi-level asthma intervention, Project BREATHE (Building Resilience, Education, and Training for Health and Environment).

Design/Methods: In the first phase of this prospective, non-randomized, observational pilot trial (#NCT06507943), we convened a transdisciplinary team-including bilingual community health workers (promotoras) from the Hispanic Federation, pediatricians, allergists, pulmonologists, and attorneys-to codesign and implement BREATHE to address asthma-related concerns, including medication adherence and environmental triggers in the home.

After iterative refinement of the pathway and intervention components through content review and usability assessments, we produced an asthma advocacy clinical pathway embedded in the electronic health record and a promotora-led home visiting community outreach intervention.

We conducted descriptive analyses to evaluate feasibility via assessments of utilization patterns of the asthma advocacy clinical pathway by clinician specialty, practice location, and provider type and of the home visiting intervention via completed referrals, completed home visits, and visit format (virtual, in-person).

Results: The asthma advocacy pathway (Figure) was completed and launched in August 2024 at primary care and pediatric pulmonary practices. Over 13 months, the pathway was utilized 209 times, involving 127 patients from 55 providers, with most usage points (79%, n=166) from primary care providers, followed by 14% (n=30) from pulmonary and allergy specialists. Trainees (residents, students) accounted for 71% of pathway users (n=39), followed by general pediatricians (18%, n = 10). From September 2024-October 2025, 72 referrals were placed to the home visiting program via this pathway, and 31% of patients (n=22) received at least one visit (8 had one visit, 14 completed two visits) (Table). The majority (72%) of visits were conducted virtually, per patient preference.

Conclusion(s): In this feasibility evaluation of a multi-level asthma home visiting intervention pilot, an asthma advocacy pathway was accessed frequently by trainees and primary care physicians, and flexible (in-person or virtual) home-visiting had 31% uptake by referred patients. Further evaluations of this multi-level, interdisciplinary, community-driven intervention for asthma support and advocacy will assess appropriateness, acceptability, and preliminary efficacy.

Asthma Advocacy Pathway
Pathway linked within clinical asthma care pathways. Referrals to promotora home visiting intervention in this pathway as "Refer to Asthma Home Visiting Program," and hyper-link opens box with inclusion criteria for reference. Pathway embedded within patient electronic health records and publicly available at the "ambulatory" link through Yale Clinical Pathways: https://www.ynhh.org/childrens-hospital/medical-professionals/clinical-pathways

Table. Asthma Advocacy Pathway Utilization in Electronic Health Records from 09/2024-10/2025