Limits...
A longitudinal study of adult-onset asthma incidence among HMO members.

Sama SR, Hunt PR, Cirillo CI, Marx A, Rosiello RA, Henneberger PK, Milton DK - Environ Health (2003)

Bottom Line: New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies.Computerized HMO records can be successfully used to identify AOA.We demonstrated that clinicians attribute most AOA to infection and tend to ignore the contribution of environmental and occupational exposures.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA. ssama@hsph.harvard.edu

ABSTRACT

Background: HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored.

Methods: We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm.

Results: The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%.

Conclusion: Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of provider consideration of etiologies. We demonstrated that clinicians attribute most AOA to infection and tend to ignore the contribution of environmental and occupational exposures.

Show MeSH

Related in: MedlinePlus

Annualized adult-onset asthma incidence-March 2000–February 2001
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC194432&req=5

Figure 1: Annualized adult-onset asthma incidence-March 2000–February 2001

Mentions: The monthly average eligible population consisted of 61,892 HMO members including 55,905 at-risk of developing asthma. The monthly, computerized searches identified 746 potential cases for the 12-month period March 2000 through February 2001. On average, 62 potential cases were identified each month and 39 were confirmed by chart review. The incidence of confirmed AOA varied by month and trends for new-onset and reactivated asthma were similar (Figure 1). The incidence over the one-year study period was 3.8 per 1000 persons for new-onset cases, 4.6 per 1000 for reactivation of asthma after at least one year of inactivity and 8.4 per 1000 combined.


A longitudinal study of adult-onset asthma incidence among HMO members.

Sama SR, Hunt PR, Cirillo CI, Marx A, Rosiello RA, Henneberger PK, Milton DK - Environ Health (2003)

Annualized adult-onset asthma incidence-March 2000–February 2001
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC194432&req=5

Figure 1: Annualized adult-onset asthma incidence-March 2000–February 2001
Mentions: The monthly average eligible population consisted of 61,892 HMO members including 55,905 at-risk of developing asthma. The monthly, computerized searches identified 746 potential cases for the 12-month period March 2000 through February 2001. On average, 62 potential cases were identified each month and 39 were confirmed by chart review. The incidence of confirmed AOA varied by month and trends for new-onset and reactivated asthma were similar (Figure 1). The incidence over the one-year study period was 3.8 per 1000 persons for new-onset cases, 4.6 per 1000 for reactivation of asthma after at least one year of inactivity and 8.4 per 1000 combined.

Bottom Line: New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies.Computerized HMO records can be successfully used to identify AOA.We demonstrated that clinicians attribute most AOA to infection and tend to ignore the contribution of environmental and occupational exposures.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA. ssama@hsph.harvard.edu

ABSTRACT

Background: HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored.

Methods: We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm.

Results: The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%.

Conclusion: Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of provider consideration of etiologies. We demonstrated that clinicians attribute most AOA to infection and tend to ignore the contribution of environmental and occupational exposures.

Show MeSH
Related in: MedlinePlus