A Risk Stratification Algorithm for Asthma Identification and Prioritization in a Low‐Income Urban School

• Published in: The Journal of school health Vol. 90; no. 7; pp. 538 - 544
• Main Authors: Rabner, Marc, Bissett, Katherine, Johnson, Sara B., Connor, Katherine A.
• Format: Journal Article
• Language: English
• Published: Malden, USA Wiley Periodicals, Inc 01-07-2020; Wiley-Blackwell; Blackwell Publishing Ltd
• Subjects: Absenteeism; Algorithms; Asthma; asthma screening; At Risk Students; Attendance; Childrens health; Chronic Illness; Disease management; Diseases; Elementary School Students; Grade 1; Health care delivery; Health Programs; Incidence; Low Income Students; Mathematics; Medical screening; Middle School Students; Nursing; Reliance; School attendance; school health; School Health Services; School Nurses; school nursing; Screening Tests; Stratification; Student Needs; Students; Urban Schools; United States > US; school nursing; asthma; asthma screening; school health
• ISSN: 0022-4391; 1746-1561
• DOI: 10.1111/josh.12903

ABSTRACT
BACKGROUND
Asthma can interfere with school attendance and engagement. School health programs are central to asthma management. Case identification is limited by reliance on parent‐completed forms, which are often missing. This project tested a low‐burden screening algorithm to stratify students based on priority for nurse outreach at 2 large, urban schools with high asthma prevalence.
METHODS
Students in grades 1‐8 completed a 4‐item asthma screener. Two‐stage stratification incorporated screener responses, school nurse records, and absenteeism. Students were assigned low, medium, or high priority for follow up. Asthma prevalence in the high priority group was calculated for substantiated asthma. Whether stratification was more likely than chance to identify new cases of asthma in the high‐priority group was evaluated using chi‐square tests.
RESULTS
Of 1397 students, 69.7% were screened. Secondary stratification decreased the number of students in the high and medium priority groups. New asthma cases were identified in 46.4% of high‐priority families reached for follow up. High‐priority students were more likely to be identified as having asthma than chance alone (p < .001).
CONCLUSIONS
A low‐burden screening algorithm appropriately placed students with asthma in the high priority group. This approach may allow efficient, targeted follow up of the highest need students in high prevalence populations.