Using Complex, Multi-Sectoral Data in a Needs Assessment to Inform Future Strategies in Childhood Asthma Management

The purpose of this needs assessment was to study the current state of asthma management in high-risk children in Houston, Texas to inform a theory-based approach to improving asthma management. The mixed-method assessment included multi-sectoral survey, quantitative, and geospatial data that address a range of social and community factors in family, community, home, and medical contexts. Houston Emergency Medical Services (EMS) provided ambulance-treated asthma data mapped by geographic area to identify where childhood asthma management was weakest. Texas Children’s Health Plan (TCHP) provided medication compliance rates and counts of children by zip code that TCHP considered high-risk according to claims data. Houston Independent School District (HISD) provided school nurse survey results from schools with high-rates of ambulance-treated asthma attacks regarding local barriers to asthma management. Elementary schools with children at highest risk were identified by overlaying the EMS data, TCHP data, and HISD school zone boundaries. Survey results from the high-rate schools indicate the priority challenges to childhood asthma management, including lack of resources, lack of communication, lack of knowledge of triggers, and inadequate time for quality care from providers. By weaving together EMS, TCHP, and HISD data, the needs assessment informed a socio-ecological view of gaps in high-risk childhood asthma management and control, specifically where and what to target. An assessment approach with multi-sectoral data, geospatial mapping, nurse input, current systems of care, education, and funding helped focus planning on a practical approach to asthma control solutions for high-risk children

Association of Out-of-Hospital Cardiac Arrest with Exposure to Fine Particulate and Ozone Ambient Air Pollution from Case-Crossover Analysis Results: Are the Standards Protective?

About 300,000 cardiac arrests occur outside of hospitals in the United States each year; most are fatal. Studies have shown that a small but significant percentage of cardiac arrests appear to be triggered by exposure to increased levels one of two air pollutants: fine particulate matter and ozone. We analyzed seven key studies to determine if Environmental Protection Agency (EPA) standards protect the public from out-of-hospital cardiac arrests (OHCA) triggered by exposure to fine particulate matter and ozone. Using Houston, Texas, data, we found evidence of an increased risk of cardiac arrest on the order of 2% to 9% due to an increase of fine particulate levels (a daily average increase of 10 µg/m3) on the day of, or day before, the heart attack. The EPA fine particulate standard of 35 µg/m3 (35 micrograms per cubic meter of air) therefore does not effectively protect the public from OHCA triggered by exposure to fine particulates. However, the EPA’s ozone standard does appear to adequately protect public health from OHCA triggered by exposure to ozone

Cross-Disciplinary Consultancy to Enhance Predictions of Asthma Exacerbation Risk in Boston

This paper continues an initiative conducted by the International Society for Disease Surveillance with funding from the Defense Threat Reduction Agency to connect near-term analytical needs of public health practice with technical expertise from the global research community.  The goal is to enhance investigation capabilities of day-to-day population health monitors. A prior paper described the formation of consultancies for requirements analysis and dialogue regarding costs and benefits of sustainable analytic tools.  Each funded consultancy targets a use case of near-term concern to practitioners.  The consultancy featured here focused on improving predictions of asthma exacerbation risk in demographic and geographic subdivisions of the city of Boston, Massachusetts, USA based on the combination of known risk factors for which evidence is routinely available.A cross-disciplinary group of 28 stakeholders attended the consultancy on March 30-31, 2016 at the Boston Public Health Commission (BPHC).Known asthma exacerbation risk factors are upper respiratory virus transmission, particularly in school-age children, harsh or extreme weather conditions, and poor air quality.  Meteorological subject matter experts described availability and usage of data sources representing these risk factors.  Modelers presented multiple analytic approaches including mechanistic models, machine learning approaches, simulation techniques, and hybrids.  Health department staff and local partners discussed surveillance operations, constraints, and operational system requirements.  Attendees valued the direct exchange of information among public health practitioners, system designers, and modelers.  Discussion finalized design of an 8-year de-identified dataset of Boston ED patient records for modeling partners who sign a standard data use agreement