Development of a conceptual model of childhood asthma to inform asthma prevention policies

BackgroundThere is no definitive cure for asthma, as prevention remains a major goal. Decision analytic models are routinely used to evaluate the value-for-money proposition of interventions. Following best practice standards in decision-analytic modelling, the objective of this study was to solicit expert opinion to develop a concept map for a policy model for primary prevention of asthma.MethodsWe reviewed currently available decision analytic models for asthma prevention. A steering committee of economic modellers, allergists and respirologists was then convened to draft a conceptual model of paediatric asthma. A modified Delphi method was followed to define the context of the problem at hand (evaluation of asthma prevention strategies) and develop the concept map of the model.ResultsConsensus was achieved after three rounds of discussions, followed by concealed voting. In the final conceptual model, asthma diagnosis was based on three domains of lung function, atopy and their symptoms. The panel recommended several markers for each domain. These domains were in turn affected by several risk factors. The panel clustered all risk factors under three groups of ‘patient characteristic’, ‘family history’ and ‘environmental factors’. To be capable of modelling the interplay among risk factors, the panel recommended the use of microsimulation, with an open-population approach that would enable modelling phased implementation and gradual and incomplete uptake of the intervention.ConclusionsEconomic evaluation of childhood interventions for preventing asthma will require modelling of several codependent risk factors and multiple domains that affect the diagnosis. The conceptual model can inform the development and validation of a policy model for childhood asthma prevention.

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Development of a Conceptual Model of Childhood Asthma to Inform Asthma Prevention Policies

10.1101/2020.12.15.20248275 ◽

2020 ◽

Author(s):

Amin Adibi ◽

Stuart E Turvey ◽

Tae Yoon Lee ◽

Malcolm R Sears ◽

Allen B Becker ◽

...

Keyword(s):

Risk Factors ◽

Conceptual Model ◽

Childhood Asthma ◽

Large Scale ◽

Concept Map ◽

Policy Model ◽

Open Population ◽

Characteristic Family ◽

Asthma Prevention ◽

Analytic Models

AbstractBackgroundThere is no definitive cure for asthma; as such, prevention remains a major goal. Decision-analytic models are routinely used to evaluate the value-for-money proposition of interventions. Following best practice standards in decision-analytic modeling, the objective of this study was to solicit expert opinion to develop a concept map for a policy model for primary prevention of asthma.MethodsWe reviewed currently available decision-analytic models for asthma prevention. A steering committee of economic modelers, allergists, and respirologists was then convened to draft a conceptual model of pediatric asthma. A modified Delphi method was followed to define the context of the problem at hand (evaluation of asthma prevention strategies) and develop the concept map of the model.ResultsConsensus was achieved after three rounds of discussions, followed by concealed voting. In the final conceptual model, asthma diagnosis was based on three domains of lung function, atopy, and their symptoms. The panel recommended several markers for each domain. These domains were in turn affected by several risk factors. The panel clustered all risk factors under three groups of ‘patient characteristic’, ‘family history’, and ‘environmental factors’. To be capable of modeling the interplay among risk factors, the panel recommended the use of microsimulation, with an open-population approach that would enable modeling phased implementation and gradual and incomplete uptake of the intervention.ConclusionsEconomic evaluation of childhood interventions for preventing asthma will require modeling of several co-dependent risk factors and multiple domains that affect the diagnosis. The conceptual model can inform the development and validation of a policy model for childhood asthma prevention.FundingGenome Canada Large-Scale Applied Research Project

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Faculty Opinions recommendation of Toward primary prevention of asthma. Reviewing the evidence for early-life respiratory viral infections as modifiable risk factors to prevent childhood asthma.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725223247.793531816 ◽

2017 ◽

Author(s):

Erik Melen

Keyword(s):

Risk Factors ◽

Primary Prevention ◽

Childhood Asthma ◽

Early Life ◽

Viral Infections ◽

Modifiable Risk Factors ◽

Respiratory Viral Infections

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Ergonomic Process Improvement for Mapping Risk and Identifying Key Interventions for Eliminating Injuries from Needles and Sharps in the OR

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181320641166 ◽

2020 ◽

Vol 64 (1) ◽

pp. 716-720

Author(s):

Pramila Kalaga ◽

Barbara Wolford ◽

Matthew Mormino ◽

Timothy Kingston ◽

Julie Fedderson ◽

...

Keyword(s):

Risk Factors ◽

Process Improvement ◽

Injury Risk ◽

Best Practice ◽

Physical Workload ◽

Physical Factors ◽

Improvement Project ◽

Targeted Interventions ◽

Effective Interventions ◽

Sharps Injury

The risk of a needle stick or sharps injury in the operating room (OR) is high due to conditions such as minimal physical protective measures, frequent transfer of sharps, and reliance on human attention and skill for injury avoidance. An ergonomic process improvement project was initiated at a large metro teaching hospital to identify ergonomic risk factors for these OR injuries. To maximize the engagement of the front- end users, an ergonomic process improvement (EPI) team was developed, consisting of representatives from participating OR teams, an employee health nurse and two ergonomists. Surveys, observations, and interviews were conducted to quantify injury risk for the OR teams, evaluate barriers to best practice adherence, and identify opportunities for targeted interventions. Risk mapping was completed for the surgeons, surgical techs and OR nurses identifying double gloving and safe passing zone as areas in need of improvement. Through observation and interviews, researchers identified physical factors relating to musculoskeletal pain and cognitive factors leading to distractions as safety risk concerns. The overall success of the EPI was the engagement of the OR teams and surgeons in the process of identifying risk factors and potential opportunities for ergonomic solutions related to cognitive workload, physical workload, teamwork, and work design for injury prevention. The risk factors identified will provide the basis for developing targeted, effective interventions for eliminating injuries from needles and sharps within the OR.

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Patient preferences for use of virtual consultations in an orthopaedic rehabilitation setting: Results from a discrete choice experiment

Journal of Health Services Research & Policy ◽

10.1177/13558196211035427 ◽

2021 ◽

pp. 135581962110354

Author(s):

Anthony W Gilbert ◽

Emmanouil Mentzakis ◽

Carl R May ◽

Maria Stokes ◽

Jeremy Jones

Keyword(s):

Conceptual Model ◽

Discrete Choice Experiment ◽

Discrete Choice ◽

Patient Preferences ◽

Choice Experiment ◽

Best Practice ◽

Time Of Day ◽

Problem Area ◽

Fractional Factorial ◽

The Impact

Objective Virtual Consultations may reduce the need for face-to-face outpatient appointments, thereby potentially reducing the cost and time involved in delivering health care. This study reports a discrete choice experiment (DCE) that identifies factors that influence patient preferences for virtual consultations in an orthopaedic rehabilitation setting. Methods Previous research from the CONNECT (Care in Orthopaedics, burdeN of treatmeNt and the Effect of Communication Technology) Project and best practice guidance informed the development of our DCE. An efficient fractional factorial design with 16 choice scenarios was created that identified all main effects and partial two-way interactions. The design was divided into two blocks of eight scenarios each, to reduce the impact of cognitive fatigue. Data analysis were conducted using binary logit regression models. Results Sixty-one paired response sets (122 subjects) were available for analysis. DCE factors (whether the therapist is known to the patient, duration of appointment, time of day) and demographic factors (patient qualifications, access to equipment, difficulty with activities, multiple health issues, travel costs) were significant predictors of preference. We estimate that a patient is less than 1% likely to prefer a virtual consultation if the patient has a degree, is without access to the equipment and software to undertake a virtual consultation, does not have difficulties with day-to-day activities, is undergoing rehabilitation for one problem area, has to pay less than £5 to travel, is having a consultation with a therapist not known to them, in 1 weeks’ time, lasting 60 minutes, at 2 pm. We have developed a simple conceptual model to explain how these factors interact to inform preference, including patients’ access to resources, context for the consultation and the requirements of the consultation. Conclusions This conceptual model provides the framework to focus attention towards factors that might influence patient preference for virtual consultations. Our model can inform the development of future technologies, trials, and qualitative work to further explore the mechanisms that influence preference.

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Trends in prevalence and risk factors of childhood asthma in Fuzhou, a city in Southeastern China

Journal of Asthma ◽

10.3109/02770903.2014.952434 ◽

2014 ◽

Vol 52 (1) ◽

pp. 10-15 ◽

Cited By ~ 7

Author(s):

Su-Ping Tang ◽

Yan-Lin Liu ◽

Shi-Biao Wang ◽

Sheng-Feng Weng ◽

Shen Chen ◽

...

Keyword(s):

Risk Factors ◽

Childhood Asthma ◽

Southeastern China

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Meat consumption among 18-month-old children participating in the Childhood Asthma Prevention Study

Nutrition & Dietetics ◽

10.1111/j.1747-0080.2005.tb00004.x ◽

2005 ◽

Vol 62 (1) ◽

pp. 12-20 ◽

Cited By ~ 15

Author(s):

Karen Webb ◽

Ingrid Rutishauser ◽

Tamarah Katz ◽

Natalia Knezevic ◽

Marjaana Lahti-Koski ◽

...

Keyword(s):

Childhood Asthma ◽

Meat Consumption ◽

Prevention Study ◽

Asthma Prevention

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Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020486 ◽

2021 ◽

Vol 18 (2) ◽

pp. 486

Author(s):

Pavani Rangachari ◽

Jie Chen ◽

Nishtha Ahuja ◽

Anjeli Patel ◽

Renuka Mehta

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Risk Factor ◽

Childhood Asthma ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Primary Research ◽

Ed Visits ◽

The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

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