Using Randomized Controlled Trials to Estimate the Effect of Community Interventions for Childhood Asthma

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Asthma is a major public health concern, leading to numerous emergency department (ED) visits and hospitalizations in children.
• The Centers for Disease Control and Prevention's initiative aims to significantly reduce these events through evidence-based interventions.
• Accurate methods are needed to estimate the impact of planned and existing asthma programs.

Purpose of the Study:

• To develop and illustrate a method for calculating the anticipated effects of asthma interventions on adverse asthma events (AAEs).
• To estimate changes in AAE rates resulting from expanded access to asthma interventions using data from randomized control trials (RCTs).

Main Methods:

• Utilized counterfactual arguments to derive a formula for estimating the number of AAEs prevented by an intervention.
• The formula incorporates the current AAE rate, the increase in intervention access, and the rate ratio from RCTs.
• Applied the method to estimate the impact of asthma self-management education on ED visits and hospitalizations.

Main Results:

• Demonstrated a formula for estimating the effect of expanding access to asthma interventions.
• An example showed that offering asthma self-management education to 20% of patients could decrease annual ED visits by an estimated 1,643 and hospitalizations from 2,639 to 617.

Conclusions:

• The proposed method effectively estimates the community-level impact of expanding asthma interventions.
• This approach leverages robust evidence from RCTs to predict reductions in AAEs, informing public health strategies for asthma control.