Using the ecology model to describe the impact of asthma on patterns of health care

BACKGROUND: Asthma changes both the volume and patterns of healthcare of affected people. Most studies of asthma health care utilization have been done in selected insured populations or in a single site such as the emergency department. Asthma is an ambulatory sensitive care condition making it important to understand the relationship between care in all sites across the health service spectrum. Asthma is also more common in people with fewer economic resources making it important to include people across all types of insurance and no insurance categories. The ecology of medical care model may provide a useful framework to describe the use of health services in people with asthma compared to those without asthma and identify subgroups with apparent gaps in care. METHODS: This is a case-control study using the 1999 U.S. Medical Expenditure Panel Survey. Cases are school-aged children (6 to 17 years) and young adults (18 to 44 years) with self-reported asthma. Controls are from the same age groups who have no self-reported asthma. Descriptive analyses and risk ratios are placed within the ecology of medical care model and used to describe and compare the healthcare contact of cases and controls across multiple settings. RESULTS: In 1999, the presence of asthma significantly increased the likelihood of an ambulatory care visit by 20 to 30% and more than doubled the likelihood of making one or more visits to the emergency department (ED). Yet, 18.8% of children and 14.5% of adults with asthma (over a million Americans) had no ambulatory care visits for asthma. About one in 20 to 35 people with asthma (5.2% of children and 3.6% of adults) were seen in the ED or hospital but had no prior or follow-up ambulatory care visits. These Americans were more likely to be uninsured, have no usual source of care and live in metropolitan areas. CONCLUSION: The ecology model confirmed that having asthma changes the likelihood and pattern of care for Americans. More importantly, the ecology model identified a subgroup with asthma who sought only emergent or hospital services

Reconstructing readiness: Young children’s priorities for their early school adjustment

Young children in communities facing socioeconomic disadvantage are increasingly targeted by school readiness interventions. Interventions are stronger if they address stakeholders’ priorities, yet children’s priorities for early school adjustment are rarely accounted for in intervention design including selection of outcome measures. The Children’s Thoughts about School Study (CTSS) examined young children’s accounts of their early school experiences, and their descriptions of what a new school starter would need to know. Mixed-method interviews were conducted with 42 kindergarten children in a socioeconomically deprived suburb of Dublin, Ireland. First, inductive thematic analysis identified 25 priorities across four domains: feeling able and enthusiastic for school; navigating friendships and victimisation; supportive environments with opportunities to play; bridging school and family life. Second, deductive analysis compared children’s priorities at item level against a school readiness outcome battery. Children’s priorities were assigned to three groups: (1) assessed by outcome measures (core academic competencies, aspects of self regulation); (2) partially assessed (self-efficacy, social skills for friendship formation and avoiding victimisation, creative thinking, play); and (3) not assessed by outcome measures (school liking, school environment, family school involvement). This analysis derived from children’s own perspectives suggests that readiness interventions aiming to support early school adjustment would benefit from considering factors children consider salient. It offers recommendations for advancing conceptual frameworks, improving assessment, and identifying new targets for supporting children and schools. In doing so we provide a platform for children’s priorities to be integrated into the policies and practices that shape their early lives

National Education Goals Panel

The National Education Goals Panel (NEGP) is a unique bipartisan and intergovernmental body of federal and state officials created in July 1990 to assess and report state and national progress toward achieving the National Education Goals. Under the legislation, the Panel is charged with a variety of responsibilities to support systemwide reform, including: reporting on national and state progress toward the Goals over a 10-year period; working to establish a system of high academic standards and assessments; identifying actions for federal, state, and local governments to take; and building a nationwide, bipartisan consensus to achieve the Goals

A report of the Goal 1 Ready Schools Resource Group

To the National Education Goals Panel, ensuring that children start school ready to learn is vitally important. But ensuring that schools are ready for children is important as well. Recognizing that good education means both ready children and ready schools, the Goals Panel convened a special group of advisors and asked them to identify what makes a ready school. This report, Ready Schools, is the result of their efforts. It recommends ten specific approaches found in successful elementary schools and documented by research to be keys to ready schools