C25-18 Multi-level Asthma Advocacy Pathway and Home Visiting Intervention Pilot: Breathe Team

Abstract Rationale Children living in New Haven, Connecticut have the highest rate of asthma-related morbidity in the state. In this study, we aimed 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). 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). The majority (72%) of visits were conducted virtually, per patient preference. Conclusions 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. This abstract is funded by: Community Health Equity Accelerator Pilot from the Office of Health Equity at Yale School of Medicine