Targeting Improvements in Asthma Morbidity in Chicago: Surveillance Initiatives

Many organizations, consortia, and collaboratives collected and distributed information on asthma prevalence and severity, attitudes, and behaviors regarding asthma therapy in various clinical settings, and knowledge and attitudes about asthma in Chicago communities. In data workshops sponsored by the CAC annually since 1997, epidemiologists, community leaders, and health-care providers have presented focused analyses of many of the issues concerning asthma in Chicago. University of Chicago and Chicago Department of Public Health epidemiologists have developed detailed maps of how asthma variably affects different neighborhoods and how treatment varies from community to community. These analyses have been critical for asthma care in Chicago and have helped to focus research and treatment programs.

Two important surveillance projects include the Chicago Asthma Surveillance Initiative (CASI) and the Illinois Emergency Department Asthma Collaborative (IEDAC). The CASI was a citywide surveillance program sponsored by the Otho S. A. Sprague Memorial Institute. The CASI had the following aims: (1) to characterize the variations in asthma care in hospitals, EDs, primary care and asthma specialty practices, managed-care organizations, and communities of Chicago and the surrounding counties; (2) to provide data to various organizations with community-wide programs in asthma education, such as the CAC; (3) to establish a method for monitoring changes in Chicago-area asthma care and effectiveness of community-wide asthma awareness efforts; and (4) to characterize awareness of asthma in various community settings.

Asthma therapy

The results from these cross-sectional surveys were featured in a CHEST Supplement’ that addressed how individuals and communities were affected by asthma, how the health-care system was responding, described asthma knowledge and care practice of health providers, and community responses to asthma in Chicago. The working groups of authors came from many universities, hospitals, community organizations, and the activity around that collaborative activity was the seed that blossomed into stronger cross-institution relationships of coinvestigators.

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The IEDAC, funded by the CDC, developed and tested an ED-based system of asthma surveillance with the goal of improving quality of care in ED asthma patients. Three surveillance instruments measured the following: (1) asthma risk assessment, (2) asthma process of care in the ED, and (3) asthma-outcomes assessment. A 15-month period of data collection assessed the feasibility and responsiveness of the proposed surveillance program. After refinement of the surveillance model, the assessment tools were transferred to an Internet environment for broader dissemination. The IEDAC showed that many children coming to Illinois EDs were not using effective controller medications, and that those who were prescribed the medications were not taking them in an effective manner. The IEDAC demonstrated the usefulness of an ED-based surveillance system in assessing asthma risk within the community, describing acute care practice in relation to national standards, and measuring relapse following an ED visit.

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