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Estimating Pediatric Asthma Prevalence in Westchester County NY: A Collaborative, Multidisciplinary Study

2. Purpose. The purpose of this study was to estimate the prevalence of pediatric asthma in Westchester County through an examination of patient records in hospital based outpatient clinics, neighborhood health centers, and pediatric practices for Year 2001.. 3. Project Participants. Westchester

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Estimating Pediatric Asthma Prevalence in Westchester County NY: A Collaborative, Multidisciplinary Study

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    1. Estimating Pediatric Asthma Prevalence in Westchester County NY: A Collaborative, Multidisciplinary Study A. Serdar Atav, PhD, Gale A. Spencer RN, PhD Nannette Van Dyke, MS, PCNP Kresge Center for Nursing Research, Decker School of Nursing, Binghamton University, New York Olcay Akman, PhD Department of Mathematics and Statistics, Coastal Carolina University, South Carolina

    2. 2 Purpose The purpose of this study was to estimate the prevalence of pediatric asthma in Westchester County through an examination of patient records in hospital based outpatient clinics, neighborhood health centers, and pediatric practices for Year 2001.

    3. 3 Project Participants Westchester County Department of Health (WCDH) Funding Agency Kresge Center for Nursing Research (KCNR), Binghamton University, New York Gale Spencer & Serdar Atav Coastal Carolina University Olcay Akman, Statistician

    4. 4 Initiation of Project In Spring of 2002, in response to a competitive call for proposals, KCNR submitted a proposal to conduct an Pediatric Asthma Prevalence Study for WCHD for year 2001. WCDP retained KCNR in Summer 2002 and the study began in early August 2002.

    5. 5 Westchester County Immediately north of New York City Considered a very wealthy suburban county Major disparities in income, education, and diversity between the north and the south

    6. 6 Project Goals Given that asthma hospitalization data was already being collected, WCDH requested a survey of pediatric asthma prevalence in three types of settings: Hospital based health clinics Neighborhood Health Centers Large private practices

    7. 7 Project Goals According to the contract, estimates of pediatric asthma prevalence in Westchester County was to be reported by: Type of setting Geographic location Age groupings Gender

    8. 8 Methodological Concerns Collection of data from all regions of the county to provide geographic representation Collection of data from different types of outpatient pediatric practices to provide accurate socio-economic representation Utilization of appropriate statistical techniques to calculate accurate prevalence estimates

    9. 9 Preparation Process While the Kresge Center had the expertise to undertake such a project, the staff did not feel totally comfortable in sampling procedures and statistical calculations. Hence the expertise of our statistician, Dr. Akman was utilized both throughout the writing of the grant proposal and the actual conduct of the project.

    10. 10 Project Methodology: Health Centers and Neighborhood Health Clinics The small number of health centers and pediatric clinics did not allow for sampling that would yield accurate representation. Thus, all were approached for data collection. All of them said that they did not have any computerized patient records. After pressure by the county officials all health centers and 2 hospital based clinics agreed to talk to us.

    11. 11 Project Methodology: Large Private Practices 20 large pediatric private practices were identified by WCDH for possible inclusion in the study. After stratifying for the six health planning regions of the county, six private practices were randomly selected and approached for data gathering.

    12. 12 Data Collection Issues Geographical and type of site representation was secured by the participation of Three of four hospital based pediatric clinics Two of four neighborhood health centers And six private practices, four of which were selected in a non-random fashion.

    13. 13 Data Collection Methods: Upon consultation with each site, specific ICD9 codes for asthma were used to identify pediatric asthma patients for year 2001. Electronic Ten of eleven sites provided complete information on their pediatric asthma patients in electronic form. Manual A random sample of patient records was manually reviewed by the KCNR staff in a private practice

    14. 14 Data Collection Summary

    15. 15 Pooled population estimate calculations were based on the following steps: The sample proportions (for region, age, and gender groupings) The estimated population parameters. The appropriate standard errors. The 95% confidence intervals. Data Analyses Check on wording with SerdarCheck on wording with Serdar

    16. 16 Data Projections and Extrapolations Data projection was conducted by the calculation of sample proportions multiplied by the total number of records. When age data was not provided, age distribution proportions from the specific regions were used as weights to calculate estimated frequencies for age groups. When gender data was not provided, Westchester County percentages for gender distribution were used as weights in calculations (48% Female, 52% Male).

    17. 17 Calculations

    18. 18 Findings: By Type of Setting

    19. 19 Asthma Prevalence By Type of Setting

    20. 20 Findings: By Region

    21. 21 Asthma Prevalence By Region

    22. 22 Findings: By Age

    23. 23 Asthma Prevalence By Age Do we want to put spaces in or not??Do we want to put spaces in or not??

    24. 24 Findings: By Gender

    25. 25 Asthma Prevalence By Gender

    26. 26 The Role of Westchester County Health Department Funding Agency. Provided list of possible sites and names of contact people. Sent a letter to all possible sites informing them about the study. Established contacts.

    27. 27 The role of the statistics consultant: Technical aspects of the grant proposal Sampling process Formulas for population estimation Reality check throughout the project: Since we cant do this, if we do that, will it make any statistical sense? This is what is happening. What do we need to do to be able to use the data? Provision of a very adaptable and user friendly Excel calculator for population estimations. The (psychological) comfort of sharing the responsibility of statistical aspects of the project Last, but not least, the respectability that the statistician brings to the project from the perspective of the funding agency

    28. 28 Conclusion: The challenges of cooperating with colleagues across disciplines and distances were: Finding a common ground among various vested interests politics, patient confidentiality, statistics, and sound research procedures Finding a common language to communicate issues among collaborators Health Department, providers, and academic Facilitators: Common goal One direct point of contact (for a period only) Good relationship between the academic participants Findings were very well accepted by the Health Department and the Asthma Council.

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