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Minutes of the Asthma
Surveillance Committee - Conference Call Meeting
December 20, 2002, 1:30 - 3 p.m.
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Facilitator: Kathryn Angell
Minutes taken by:
Laurie Stillman, Executive Director of ARC
Participants by State and/or Affiliation:
Betsy Rosenfeld (USDHHS), Laurie Stillman (ARC), Kathryn Angell (Consultant)
Mary Lou Fleissner: Connecticut DPH and ARC Surveillance Committee Chair
Robert Knorr and Frances Dwyer: Massachusetts DPH
Annette Rexroad, Anita LaPointe and Jessie Brosseau: Vermont DPH
Katherine Rannie: New Hampshire Department of Education
Jo Porter and Jody Wilson: New Hampshire DPH
Katie Meyer and Kathy Tippy: Maine DPH
Elena Nicollela: USDHHS CMS Office
Lou Ann Rhodes (CDC
I. Introduction and Background
Rosenfeld spoke about the history and purpose of ARC and its
interdisciplinary approach and about the national perspective on why
this effort of coordinating Asthma Surveillance activities is so important.
Stillman spoke about how there is a federal impetus to develop a national
health tracking system and that ARC would be happy to facilitate communication
and coordination between the New England states to help promote this
goal. Both emphasized the importance of coordination across state lines
on health surveillance data if it is to be eventually integrated with
outdoor environmental data as part of a national environmental health
tracking system.
II. Discussion
1. Current Activities
in New England States
Observation by Kathy Angell: The Regional Surveillance Grid that
we distributed by email illuminated that all of the 6 N.E. states are
using similar data sources for their surveillance activities. She asked
participants: What unique activities are taking place in your states
utilizing these sources?
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a. Maine – Tippy:
Maine has implemented a kindergarten child health survey that looks
broadly at asthma incidence, height and weights, and oral health.
Hoping to conduct this survey at kindergarten screenings every other
year, although it is very time consuming and resource intensive.
Currently piloting the same survey in 5th grade every other year.
Observation: It helps to get buy-in when you look at a variety of
other public health issues at the same time, such as obesity. The
asthma questions were asked both of the parents and of the children.
Their answers will be compared. |
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b. Massachusetts - Knorr
and Dwyer: Massachusetts has an Environmental Public Health Tracking
Implementation Grant. The grant will build on their previous study,
which tested school nurses’ accuracy in reporting of asthma
cases in both public and private schools in one region of the state.
Physician validation showed that school nurses are very accurate
reporters. Their results of school based reporting showed a very
different picture of asthma prevalence than the traditional data
sources that have been used, such as E.R. visits and vital records.
Their CDC tracking grant will expand this school nurse survey to
180 school districts (1/2 of all state districts).
Will also do school indoor air quality (IAQ) assessments of about
100 schools and match the results with the asthma data they collect.
Three variables will be analyzed: gender, grade, race/ethnicity
of asthmatic children. This information will generate a school building-by-building
report, with district totals. (Everyone was interested in knowing
which IAQ measurements they will be using. Knorr said they would
be happy to share this info.) |
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c. Connecticut – Fleissner:
Children’s Health Council looked at encounter data from Medicaid.
Got a prevalence rate of Medicaid patients and analyzed hospital
and emergency room usage by locality, which was very valuable
in gauging the different hospital usage rates for similar prevalence
rates. They would like to pilot another study with Medicaid, if
funding permits.
Medicaid MCOs did survey of
their patients who used the emergency room for asthma attacks
to determine why there was such a variance by region, including
whether the children had asthma action plans.
CT DPH would like to do more
with Medicaid, but there is a budget crunch. Dwyer from MA said
that she was cautious about using Medicaid data because the population
is so fluid. Fleissner pointed out that she only looked at data
of those who have been continuously enrolled.
Tippy from ME asked- What
algorithm was used to collect Medicaid data in CT? Fleissner said:
number of children who had one visit from DRGs, children who had
more than 1 visit, pharmacy data and combinations of all of these.
Tippy’s Medicaid prevalence rate in ME seemed low, while
Fleissner’s in CT noted hers appeared high. They should speak
further about this.
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d. New Hampshire – Rannie:
Collects info. on different health conditions in schools, including
asthma. The results corresponded to national data. Three groupings:
K-4, 5-8, 9-12. The info is collected electronically at the end
of year from school nurses. N.H. has 600 schools, and 200 participated.
Electronic data is new for nurses, which may account for low participation
rate, but they expect increased response rate next year. Also,
the end of year is a difficult time for nurses to take on extra
activities. Wasn’t successful in getting absenteeism rates,
despite trying.
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e. BRFSS - Rosenfeld,
Rhodes, Porter: - A coordinated pediatric asthma module was added
to last year’s BRFSS in all six New England states. There are
some concerns with the weighting by RTI, who provided the results.
All of the states have asked for the results from CDC. RTI not only
examined New England’s data, but also other states which had
a pediatric asthma module. One problem was that RTI used an SMSA
system, which is not necessarily a good geographic measure in New
England. Another question that arose: Can the states ask demographic
questions differently and still get a regional picture? The BRFSS
coordinators have put together a list of questions and concerns
about the weighting process and submitted it to an outside consultant
from Texas, Kevin Condon. Porter will send a copy of the list to
Rhodes. The consultant agreed to look at the list of concerns and
figure out how to address them. He will let us know what the time
and cost will be. There may be some funding support available from
Cox Foundation funds through ARC for this analysis. Rosenfeld emphasized
that we are going to generate appropriate weighting, but it might
take a little more time and money than we had originally hoped. |
III. Potential Future Collaborations
Ms. Angell posed the following
question about future collaborations of this group. What are some areas
where it may be helpful to work together through subcommittees, such
as BRFSS, or school surveillance, developing common reports, environmental
tracking, collecting Medicaid data, etc?
The following are specific areas and names
of interested parties where there is interest in collaboration through
subcommittees of the larger ARC Surveillance Committee:
- BRFSS- This subcommittee has already
been working together for a while under the coordination of Betsy
Rosenfeld. Determining appropriate weighting for pediatric data is
a high priority.
- Medicaid Subcommittee- Fleissner CT,
Tippy ME, Wilson NH (Porter – NH?), LaPointe VT, Dwyer MA, Nicolella
CMS - One possible area to work on is standardizing algorithms used
to look at Medicaid data, including pharmacy data, combinations of
data, HEDIS
- CDC Environmental Tracking Grants
– It was pointed out that most states are just in the planning
phase (except MA), and that it might be somewhat early to meet at
this point. On the other hand, there was a general feeling that meeting
early on could also be the most opportune and least burdensome time
to begin coordination, BEFORE decisions have been cast in stone within
each state as to how the environmental tracking system will be set
up; early timing may be ideal for coordination and ”economies
of scale”, i.e. leveraging the CDC grant dollars by sharing ideas
and approaches. CT will do a needs assessment before committing to
asthma as a disease category. Wilson from NH is intending to work
on asthma and air pollution; they haven’t hired any staff yet.
She hopes to have staffing in place by early January. (Contact Jodi
Wilson if you know of good people.) NH and MA would be interested
in collaborating with the other states in this area as well.
- Hospital and Death Data- Dwyer from
MA stated MA experience that this data is not reliable for assessing
pediatric asthma prevalence and looks at them cautiously. However
Fleissner from CT says this data gives them info on which regions
are using hospital ER more than others, which is valuable in targeting
education efforts. This data set can be used together with prevalence
data. Wilson from NH would like to explore this area further with
others.
- Insurance Info: Fleissner from CT says
MCO data is hard to obtain because the data is proprietary. Tippy
in ME was able to purchase the data from MCOs. Looking at different
data sets together can be useful. The New England Public Health Managed
Care Collaborative (NEPHMCC) has some MCOs who expressed interest
in sharing their patient data. Rexroad from VT has a rep from each
of the insurers on their advisory panel and they are trying to get
aggregate data from MCOs as well. They work with the MCO’s on
initiatives, for example, getting all children on written asthma action
plans.
- School Health- Angell asked: There
have been many different approaches in this area. Should all the states
reinvent the wheel? Is there a way to talk about this issue so we
gain from all the different efforts which have been made? Rannie from
NH would like some consistent way of asking questions and thinks working
together in this area is important. She is interested in obtaining
absence rates. Tippy from ME says her kindergarten survey is very
time-consuming. They may do work with the ISACS survey. In MA, nurses
are asking the clearinghouse for copies of the Asthma Action Plans
in significant numbers after the AAP rollout by NEPHMCC. Dwyer from
MA has learned a lot from their study and would be happy to share
their lessons. Tippy in Maine and Rannie in NH would be interested
in participating. Fleissner will pass the info on to Pat Miskell to
determine interest. (One area of CT interest may be whether AAP’s
are in school records.) Rexroad in VT is interested, although they
currently have a moratorium on school surveys.
- How can the existing data be used and
reported: Rannie from NH and Wilson from NH interested in discussing
this. Wilson said factsheets from CDC will be coming out in the early
Spring. Rhodes said it will be very useful to the states and is “in
clearance” at CDC. (see below.)
- There was some interest in how to utilize
NH/NOAA real-time data, e.g. looking at asthma exacerbations and air
quality.
IV. Wrap Up
There are five main surveillance approaches
that would be worth coordinating together on possible assistance from
ARC:
a) BRFSS- Weighting results
b) Medicaid data,
c) Environmental Public Health Tracking,
especially related to CDC grants
d) Reporting on existing data sets
e) School Surveillance
High priorities identified by participants:
VT- Pediatric asthma prevalence. Possible
coordination of this data with elderly and disabled data.
NH- Reporting on data in a standardized
fashion and school data
ME- Medicaid prevalence estimates
MA- Pediatric asthma using school health
records
V. General Issues/Information
Asthma Regional Council has a new
website: www.asthmaregionalcouncil.org.
It includes a special section on Surveillance. The minutes of this meeting
will be posted there. Please send Laurie Stillman links to your state’s
surveillance activities to post on the Surveillance page. (Lstillman@tmfnet.org)
- Stillman offered to establish a list-serve on asthma surveillance
if that would be useful. Please let her know if you are interested in
this.
- NEPHMCC has started a pediatric asthma
list-serve as a form of communication between those working on pediatric
asthma. Feel free to get more information or pose questions for the
list-serve by contacting Amy Rosenstein at NEPHMCC (arosenstein@brandeis.edu).
- There will be a series of eight documents
called Asthma Surveillance Fact Sheets, that are being developed by
CDC and should be available in spring 2003. Each fact sheet discusses
a particular asthma surveillance data source (e.g. hospital discharge
datasets) and provides guidance on using the data sources for asthma
surveillance purposes--analysis standards to follow, suggested demographic
breakdowns to use in stratified analyses, definitions, discussion of
data limitations,etc. The fact sheets will be a great resource to states
and should facilitate standardization of methods and comparability of
data across states. Lou Ann Rhodes said that they are in the process
of being reviewed.
- We won’t have the results from
the National Asthma Survey for another few years. Local data is still
needed.
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