| Session Title: Evaluating Complex Multi-Site Community-Based Interventions: The Controlling Asthma in American Cities Project |
| Multipaper Session 877 to be held in Panzacola Section F3 on Saturday, Nov 14, 3:30 PM to 5:00 PM |
| Sponsored by the Health Evaluation TIG |
| Chair(s): |
| Maureen Wilce, Centers for Disease Control and Prevention, mwilce@cdc.gov |
| Abstract: In 2001, the Centers for Disease Control and Prevention funded 7 community-based coalitions to develop, implement and evaluate comprehensive, culturally appropriate asthma programs. Those programs targeted children (0-18 years) in inner-city areas with high rates of asthma prevalence and morbidity and with documented health disparities. Evaluation of this Controlling Asthma in American Cities (CAAC) project was guided by a program theory that used an ecological model of behavior change, encompassing several levels of influence on health behavior: intrapersonal, interpersonal, institutional, community and policy. This session introduces the program theory for this project and demonstrates the multifaceted approach to its evaluation. Individual papers address evaluation questions at different points in the model: one describes a participatory method for capturing changes in the local political/social/cultural environments, the second addresses challenges in evaluating an intervention that is implemented differently across sites, the final reports a low-cost methodology for measuring population -level change. |
| Evaluating the Added Value of Implementing Complex Projects Through Community-Based Coalitions |
| Elizabeth Herman, Centers for Disease Control and Prevention, ehh9@cdc.gov |
| The terms of the Controlling Asthma in American Cities Project required the 7 participating inner-city sites to identify or develop community-based coalitions through which to plan and implement a comprehensive community asthma plan. A participatory process was developed to evaluate the added value of implementing the work through coalitions, focusing on changes at the community, institutional and policy levels. That participatory process involved the collaborative development of definitions and terms, agreement upon a common theoretical model of how the coalitions operated, classification of outcomes into different categories of "added value", the development of inclusion and exclusion criteria, as well as a process of negotiation and review. This presentation reviews the steps of this collaborative process, describes the points of difficulty or disagreement, reports the outcomes of the process, and makes recommendations for improving the process in future projects. |
| A Cross-site Presentation of Key Program Variables and Process Indicators Among Family and Home Asthma Services Provided By the Controlling Asthma in American Cities Projects |
| Amanda Savage Brown, Centers for Disease Control and Prevention, abrown2@cdc.gov |
| Sheri Disler, Centers for Disease Control and Preventions, sdisler@cdc.gov |
| The Centers for Disease Control and Prevention (CDC) developed a seven-site cooperative agreement program, the Controlling Asthma in American Cities Project (CAAC), whose primary goal was the development of innovative, effective community-based interventions impacting asthma control community-wide. All CAAC sites found a need to deliver family and home asthma services (FHAS) which were multi-component (e.g., asthma self management, social services, or coordinated care), multi-trigger environmental interventions. Although specific evaluation measures were not prescribed, CDC assisted each site in developing tools (i.e. indicator grids) to track each intervention's annual progress toward accomplishing five-year targets. Information specific to FHAS was compiled from the grids and a CDC-developed cross-site survey, administered during the sites' final year of implementation, gathered additional information about program management, content, and delivery. This paper synthesizes key program variables and process indicators of six CAAC FHAS interventions for consideration by others planning to implement similar activities. |
| Use of Pharmacy Prescription Fill Data to Evaluate the Impact of a Community-Wide Asthma Project |
| Amanda Savage Brown, Centers for Disease Control and Prevention, abrown2@cdc.gov |
| Victoria Persky, University of Illinois at Chicago, vwpersky@uic.edu |
| Steven Q Davis, University of Chicago, sqdavis@gmail.com |
| Jerry A Krishnan, University of Chicago, jkrishna@medicine.bsd.uchicago.edu |
| Kwan Lee, Walgreens Health Initiatives, kwan.lee@walgreens.com |
| Edward T Naureckas, University of Chicago, tnaureka@medicine.bsd.uchiacgo.edu |
| The Controlling Asthma in America's Cities Project's Chicago site used a multifaceted approach to improve asthma care for inner-city children. Objectively evaluating the project's influence on a population-wide basis required novel methods. Asthma-related medication dispensing data obtained from a large pharmacy chain was used to assess the project's effect on appropriate asthma medication use. Appropriate medication use was defined in two ways and using two comparison groups. The most notable finding was a significant association between living in the intervention area and appropriate asthma care for children aged 5-9. This is consistent with the focus of the project's interventions on younger children and on promoting appropriate medication use. The results suggest a beneficial effect on quality of asthma care in the subgroup of children with asthma targeted by the project. This methodology has potential for evaluating medication use in the management of other diseases amenable to large-scale, community-wide interventions. |