Using outcomes of interest to plan asthma programs.
Upcoming SlideShare
Loading in...5
×
 

Using outcomes of interest to plan asthma programs.

on

  • 808 vues

Clark NM, Friedman Milanovich AF, Lachance L, Awad DF, Stoll SC. Using outcomes of interest to plan asthma programs. American Public Health Association Annual Conference, Washington DC, November, ...

Clark NM, Friedman Milanovich AF, Lachance L, Awad DF, Stoll SC. Using outcomes of interest to plan asthma programs. American Public Health Association Annual Conference, Washington DC, November, 2007.

Noreen M. Clark, Director
Center for Managing Chronic Disease
University of Michigan

Statistiques

Vues

Total des vues
808
Vues sur SlideShare
801
Vues externes
7

Actions

J'aime
0
Téléchargements
7
Commentaires
0

1 intégré 7

http://www.slideshare.net 7

Accessibilité

Catégories

Détails de l'import

Uploaded via as Microsoft PowerPoint

Droits d'utilisation

© Tous droits réservés

Report content

Signalé comme inapproprié Signaler comme inapproprié
Signaler comme inapproprié

Indiquez la raison pour laquelle vous avez signalé cette présentation comme n'étant pas appropriée.

Annuler
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Votre message apparaîtra ici
    Processing...
Poster un commentaire
Modifier votre commentaire
  • Through the Asthma Health Outcomes Project (AHOP), the University of Michigan School of Public Health (UMSPH) is assessing the current status of asthma programs in order to identify common elements of successful programs.   Through this analysis, AHOP aims to both inform community efforts to improve the lives of people with asthma, and to guide future funding and research to ensure that resources are invested in efforts that have the greatest chance of improving health outcomes for people with asthma.
  • At the initiation of this project, AHOP convened an Expert Panel comprised of individuals with expertise in asthma, evaluation and program design to develop a framework for the program review process. With input from the Expert Panel as well as current best practice literature, we defined basic criteria for program inclusion and developed a detailed process for gathering the information needed to identify trends and factors associated with programmatic success. In order to ensure that we built on existing work, we consulted a variety of sources while developing our process, including best practice literature related to health prevention programs, a similar process conducted many years ago by colleagues at the Univ of MI related to AIDS initiatives, and the CDC’s Review of Asthma Interventions. Taking all of these into account, we started developing our process, which would continue to evolve as we got into the work: The inclusion criteria established by AHOP specify that programs must: focus on asthma, measure health outcomes, and include an environmental component.
  • Programs that used less rigorous evaluation design and analysis methods were more likely to show positive but potentially unreliable outcomes, so we examined the 65 RCT only published programs to confirm findings. The programs with the most rigorous evaluation design, RCT, were examined in order to confirm the findings from the analysis of the 111 published programs. When considering the n=65 group overall the sample size did not allow for detailed statistical comparisons among study characteristics and asthma health outcomes. However, odds ratios were calculated for all relationships in this subgroup that were shown to be significant in the n=111 group. In the slides that follow, findings that have an asterisk indicate that the odds ratio for that relationship calculated among the 65 was in the same direction as the odds ratio from the analysis of the 111 published programs.
  • Health care utilization not confirmed by analysis of 65 RCT. Other findings on this slide were confirmed.   (It is simple to remember which associations were not confirmed because they are the ones that associated programmatic factors with constructed health outcome variables that combined several outcomes into summary measures for health utilization, school and work loss, and QOL)
  • Health care utilization not confirmed by analysis of 65 RCT. Other findings on this slide were confirmed.   (It is simple to remember which associations were not confirmed because they are the ones that associated programmatic factors with constructed health outcome variables that combined several outcomes into summary measures for health utilization, school and work loss, and QOL)
  • Health care utilization not confirmed by analysis of 65 RCT. Other findings on this slide were confirmed.   (It is simple to remember which associations were not confirmed because they are the ones that associated programmatic factors with constructed health outcome variables that combined several outcomes into summary measures for health utilization, school and work loss, and QOL)
  • Community centered Building relationships that are mutually respectful, trusting, open, collaborative in nature, and that work towards common goal Strategies Build on existing resources and reduce competition Create an inclusive planning process Use Community Home Worker programs Employ local program staff Responsive to Need Considering and responding to the needs of the community, race or ethnic groups, and individuals make programs as relevant as possible to participants Strategies Conduct a needs/resource assessment and shape interventions based on community needs and resources Design program to target particular race or ethnic groups Tailor intervention based on result of individual’s assessment of trigger sensitivity and exposure Tailor program content and delivery based on participant’s individual health and educational needs Allow for creativity and flexibility so that the program can adapt to changing or newly discovered participant needs Build one-on-one relationships between staff and participants through frequent direct contact to better gauge needs and respond more effectively Collaborative Virtually all programs involved in some collaboration, history varied from longstanding to new Benefits Enhanced sustainability Gained credibility Increased support and buy-in Improved program planning and implementation Types of collaboration: Sharing resources and materials Collaborative planning processes Giving and receiving technical assistance Developing cross-referral systems Work through a coalition Joint policy change efforts Clinically Connected Programs in clinical settings and those that educated health care providers were associated with positive health outcomes. While many programs noted challenges to working with health care providers, several attributed their success to their collaborations with health care providers Strategies Attend to the needs of the health care community and develop systems and processes that are convenient and manageable Deliberately build buy-in and generate support, trust, and respect from clinicians Seek out and support “program champions”—influential opinion shapers driven by their passion and commitment
  • Final report includes frequency tables of 223 programs for all quantitative questions

Using outcomes of interest to plan asthma programs. Using outcomes of interest to plan asthma programs. Presentation Transcript

  • Using outcomes of interest to plan asthma programs
  • Goals of Asthma Health Outcomes Project (AHOP)
    • Identify characteristics of successful asthma programs that include an environmental component
    • Codify success characteristics
    • Inform ongoing asthma efforts
    • Guide future funding and research
    • Facilitate information- sharing and outcome achievement in the asthma community
  • Asthma Health Outcome Project
    • Partnership with the Indoor Environments Division of the US Environmental Protection Agency
    • Research team at Center for Managing Chronic Disease, University of Michigan:
    Noreen M. Clark, PhD Amy R. Friedman Milanovich, MPH Laurie L. Lachance, PhD, MPH Shelley Coe Stoll, MPH Daniel F Awad, MA
  • Expert Panel
    • Peyton Eggleston, MD
    • Children’s Center for Environmental Health
    • The Johns Hopkins University
    •  
    • David Evans, PhD
    • Mailman School of Public Health
    • Columbia University
    •  
    • Christine Joseph, PhD
    • Henry Ford Hospital
    • James Krieger, MD, MPH
    • Seattle-King County Public Health Department
    Toby Lewis, MD Department of Pediatrics/ School of Public Health University of Michigan Amy Murphy, MPH Milwaukee Health Department Edith A. Parker, DrPH, MPH Michigan Center for the Environment and Children’s Health (MCECH) University of Michigan School of Public Health Melissa Valerio, PhD University of Michigan School of Public Health Guided by a panel of individuals with expertise in asthma interventions:
  • Project Phases
    • Phase I: Program Identification
      • Retrieve articles published in peer-reviewed literature describing interventions and their outcomes
      • Solicit nominations of programs from over 2500 key informants around the world
  • Program Inclusion Criteria
    • Focus on asthma
    • Include an environmental component
      • e.g., education about asthma triggers, trigger remediation, system or policy change
    • Measure health outcomes
      • e.g., asthma symptoms, ED visits, hospitalizations
  • Project Phases
    • Phase II: Data Collection
      • Review literature and program documents for all eligible programs (n=427)
      • Collect data for those reporting success (n=223)
      • In depth interviews with available programs (n=169)
  • Project Phases
    • Phase III: Data Analysis
      • Quantitative
        • Frequencies of 223 programs; bivariate analyses of 111 published programs, with confirmation among the 65 published programs that evaluated with RCT
      • Qualitative
        • Analysis of responses to open-ended questions about program challenges, strengths, and unintended impacts from the set of all 223 programs
  • Data Analysis
    • Bivariate analysis to identify programmatic factors associated with positive health and environmental outcomes using published programs only (n=111)
      •  2 statistics using Fisher’s exact test at.05 significance level
    • Bivariate analysis among published RCT only programs (n=65) to confirm findings among all published programs
  • Bivariate Analysis among 111 Published Programs Background Planning and Design Implementation Administration Program Context Impact and Sustainability Health Care Utilization Quality of Life Functional Status School/Work Loss Symptoms Lung Function Medication Use Self-Management Skills Use of an Asthma Action Plan Peak Flow Meter Change in Clinical Actions Environmental Outcomes
  • AHOP Programs Total Identified Programs n=532 Ineligible n=105 Eligible n=427 Evaluation Available n=233 Not surveyed n=10 Program Survey Complete n=223 Results Published n=111 Results Unpublished n=112 RCT n=65 Non-RCT n=46 No Evaluation Available n=194
  • Limitations and Strengths
    • Limitations
    • Self-reported data
    • Programs with no positive outcomes not included
    • Some missing data for programs not interviewed (n=54)
    • Did not assess effectiveness, quality, or intensity of individual programs
    • Differences in program emphasis not accounted for
    • Strengths
    • Documented programs from 30 countries and 46 US states
    • Broad range of programs including community-based efforts not typically published and a wide variety of intervention strategies
    • Data analysis and reporting responsive to needs in field due to iterative process with experts and field practitioners
  • Findings Programmatic Factor Associated Outcome n p-value Odds Ratio [95% CI] Had an office located within the target community Hospitalizations 53 0.04 9.71 [1.00, 94.78] ED visits 44 0.04 10.18 [ 1.02, 101.52] Health care utilization 59 0.01 15.64 [1.58, 154.28] Involved community-based organizations in program planning Health care utilization 13 0.03 30.00 [1.47, 611.80] Collaborated with community-based organizations Health care utilization 16 0.04 21.00 [1.50, 293.25] Conducted a needs assessment School absences or work loss 22 0.02 22.09 [2.25, 216.6] Designed program to target a particular race or ethnic group Quality of life for parents 16 0.02 18.3 [imputed] Assessed trigger exposure Quality of life for adults 25 0.02 15.60 [1.48, 164.38]
  • Findings Programmatic Factor Associated Outcome n p-value Odds Ratio [95% CI] Tailored content or delivery based on individual participant’s health or educational needs Symptoms 54 0.03 4.81 [1.26, 18.31] Quality of life for adults 22 <0.01 121 [imputed] Quality of life for children, adults or parents 42 0.01 12.08 [1.88, 77.66] Tailored intervention based on assessed trigger sensitivity Quality of life for children 8 0.04 65 [imputed] Quality of life for children, adults or parents 14 <0.01 161 [imputed] Educated health care providers (including school nurses) School Absences 25 0.02 13.50 [1.75, 103.88] Component took place in a physician’s office or clinic ED Visits 55 0.01 4.92 [1.48, 16.34]
  • Findings Programmatic Factor Associated Outcome n p-value Odds Ratio [95% CI] Collaborated with other agencies or institutions Hospitalizations 43 0.02 8.75 [1.42, 53.91] Collaborated with governmental agencies ED Visits 29 0.04 10.00 [1.02, 95.23] Collaborated with other agencies or institutions on technical assistance Health care utilization 15 0.04 17.50 [1.22, 250.36] Collaborated with other agencies or institutions on policy action Medication use 27 0.04 10.00 [1.03, 97.50] School absences 18 0.01 24.56 [imputed]
  • Programmatic Factors, by Health Outcome
    • An office located in the target community
    • Component took place in doctor’s office or clinic
    • Involved CBOs in program planning
    • Collaborated with other agencies or institutions, especially CBOs and governmental agencies
    • Collaborated on technical assistance
    Health Care Utilization
    • Tailored intervention based on an assessment of trigger sensitivity
    • Tailored content based on individual’s health or educational needs
    • Assessed trigger exposure
    • Designed program to target particular race or ethnicity
    Quality of Life
    • Educated health care providers, including school nurses
    • Conducted a needs or resource assessment
    • Collaborated with other agencies on policy action
    School Absences and/or Work loss
    • Tailored content based on individual’s health or educational needs
    Asthma Symptoms
    • Collaborated with other agencies on policy action
    Medication Use
  • Themes of Success
    • Community-Centered
    • Responsive to Need
    • Collaborative
    • Clinically Connected
    • AHOP is a project of the Center for Managing Chronic Disease at the University of Michigan, conducted under a cooperative agreement with the Indoor Environments Division of the US Environmental Protection Agency.
  • Products
    • Complete list of all identified programs (>500) with contact information
    • Comprehensive description of each surveyed program
    • AHOP survey instrument
    • Project Reports
    available on AlliesAgainstAsthma.net/ahop