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All neighborhoods in the Bronx have high rates of diabetes long-term complications and short-term complications (except Kingsbridge/Riverdale which has a much lower rate of short-term complications). The neighborhoods with the highest discharge rates for uncontrolled diabetes are Central Bronx and High Bridge/Morrisania. In Brooklyn, the following neighborhoods have high rates: Bushwick/Williamsburg, Canarsie/Flatlands, Central Brooklyn, East New York/New Lots, and Northwest Brooklyn. Manhattan also has some neighborhoods with high diabetes-related discharge rates, including: Central Harlem, East Harlem, Greenwich Village/Soho, Upper East Side, and Upper West Side. Several neighborhoods in Queens also have high rates: Central Queens, Jamaica, Northwest Queens, Southwest Queens, and West Central Queens (Appendix 3 –Exhibit 3A andAppendix 4 –Exhibit 4C). This suggests that all of the Bronx and the specific neighborhoods listed above are in need of the greatest number or level of resources for diabetes-related preventative care and disease management to reduce Medicaid morbidity, mortality, and hospitalization rates. Asthma A number of resources exist related to the prevention and treatment of asthma and respiratory disease for both children and adults. The healthcare resources already in the ACP PPS network include PCPs and non-PCPs, in addition to other care providers (Exhibits 36 and37). The use of FQHCs and Health Homes (Exhibits 6and 7), and the development of patient-centered medical homes would be beneficial for stability in the primary care sources for people with asthma. Strong relationships with both hospitals (Exhibit 3and Appendix 1) and home health agencies (Exhibits 29and 30) also is important for continuity of care between the physician’s office, inpatient or diagnostic care, and the home setting. The NYC DOHMH offers asthma-related services through three District Public Health Offices (DPHOs) that work specifically in high-need areas in the Bronx, Manhattan, and Brooklyn. These offices offer childhood asthma education and management programs, and in Manhattan there is the East Harlem Center of Excellence that focuses exclusively on asthma prevention, education, and management for the high asthma rates in Harlem (p.45). Another potential public agency partner is the New York City Housing Authority (p. 92), since it manages housing for
154 more than 400,000 low-income residents, and because asthma “triggers” such as dust, mites, and cockroaches can exist in the home environment. Schools and libraries can potentially be engaged as a part of educational campaigns (see Health Literacy discussion, below). There also are private community-based resources working to reduce asthma rates across the four boroughs, including several community coalitions comprised of both community health and other organizations. At least four coalitions focus specifically on asthma: Asthma Coalition of Queens, Bronx RESPIRAR Asthma Coalition, North Brooklyn Asthma Action Alliance, and