Schenectady County Public Health Services

To help foster statewide implementation of prevention activities, the New York State Department of Health issued the Prevention Agenda 2013–17 to address disease prevention and reduce health disparities. All 58 local health departments were required to submit a Community Health Improvement Plan (CHIP) to the State outlining their strategies to advance the Prevention Agenda. To help energize the implementation of these CHIPs, the New York Health Foundation (NYHealth) awarded grants to health departments with the most innovative and feasible projects to improve the health and wellbeing of their communities through the Advancing New York State’s Prevention Agenda: A Matching Funds Program to Implement Community Health Improvement Plans initiative. The Prevention Agenda offered NYHealth a timely opportunity to build upon its work in diabetes prevention by helping support initiatives that tackle the root causes of diabetes and other chronic conditions, such as obesity and smoking. NYHealth awarded Schenectady County Public Health Services (SCPHS) a grant to participate in this initiative.

SCPHS used funds to focus on the Prevention Agenda priority area of preventing chronic disease. It worked to reduce the burden of preventable symptoms and conditions related to asthma by creating a care model for asthma patients at a partner hospital. Care managers were assigned to all patients who entered the emergency room with a primary diagnosis of asthma. These care managers ensured patients had all the services and supports needed to control their asthma; referred patients with asthma for a home assessment by a public health nurse to identify triggers and make referrals for home remediation; and referred patients to an asthma education program to help them learn successful techniques to better manage their condition. Care managers also assisted with coordinating care with the patient’s health care provider.