Tracking Pediatric Asthma:The Massachusetts Experience Using School Health Records

Abstract

The Massachusetts Department of Public Health, in collaboration with the U.S. Centers for Disease Control and Prevention Environmental Public Health Tracking Program, initiated a 3-year statewide project for the routine surveillance of asthma in children using school health records as the primary data source. School district nurse leaders received electronic data reporting forms requesting the number of children with asthma by grade and gender for schools serving grades kindergarten (K) through 8. Verification efforts from an earlier community-level study comparing a select number of school health records with primary care provider records demonstrated a high level of agreement (i.e., > 95%). First-year surveillance targeted approximately one-half (n = 958 schools) of all Massachusetts’s K–8 schools. About 78% of targeted school districts participated, and 70% of the targeted schools submitted complete asthma data. School nurse–reported asthma prevalence was as high as 30.8% for schools, with a mean of 9.2%. School-based asthma surveillance has been demonstrated to be a reliable and cost-effective method of tracking disease through use of an existing and enhanced reporting structure.

School‐Based Pediatric Asthma Surveillance in Massachusetts From 2005 to 2009

“…10,15,16 Furthermore, this finding is noted in other epidemiologic studies that report male sex as a risk factor for asthma. 18 On the other hand, race/ethnicity data presented a new set of challenges.…”

“…16 A total of 760 schools participated in this pilot study; 668 from the ESHS cohort, yielding a 70% response rate. Additionally, 92 other schools voluntarily submitted surveys on their own (52 private schools, 9 charter schools, and 31 other public schools) after receiving word of the project through the ESHS network.…”

Similar asthma prevalence estimates obtained from preadolescent and parent survey responses

“…Population estimates of asthma are typically obtained from responses to survey questions. Although validated questions are available for use in population-based surveys, other sources have been used for local-level asthma surveillance, particularly in schools (i.e., school health records) [1]. These sources for varying reasons (i.e., lack of standardized approach for collecting health data, how asthma is diagnosed, etc.)…”

Creation of environmental health information system for public health service: A pilot study

“…Although individual systems have long been developed, the integrative environmental health information infrastructure still remains as a hope (Hanrahan et al 2004;Knorr et al 2004;Li and Benton 2006;Zhang et al 2007).…”

“…In a mini-monograph, McGeehin et al (2004) presents results of some innovative methods for acquiring and integrating public health data through a non-traditional approach. For example, Knorr et al (2004) contacted school nurses in Massachusetts public and private schools directly to get a more reliable estimate of asthma prevalence of K-8 students at the local level. The Massachusetts Department of Public Health provided a standardized form and successfully collected asthma surveillance data from 70% of targeted schools serving more than 311,000 students through its school-based pediatric asthma surveillance system.…”