The Kaiser Permanente-Community Clinics Health Network (KP-CCHN) Partnership was created in 2004 to improve access to asthma care for uninsured school-aged children between the ages of 6-17. Historically a number of asthma projects countywide have been directed to children ages five and under, and have been funded by the First 5 Commission as well as the state. This was the first program that was directed to children in elementary, middle, or high school. The program is meeting the documented need of uninsured school-aged children to access the primary and specialty asthma care they need.
Treatment Pool. CCHN has established an asthma treatment pool for uninsured children ages 6-17. CCHN administers this pool, and clinics request reimbursement for services to uninsured children to cover the cost of asthma visits, procedures, medications, and asthma breathing devices. Clinics access this pool by submitting a claim form requesting payment for services provided to uninsured children. A list of covered treatment services include:
- Asthma Visits: Initial and subsequent visits
- Procedures: Chest x-ray, inhalation therapy, peak flow therapy, pulse oximetry, and sputum induction
- Asthma medications: Albuterol MDI (generic) and nebulizer solution, Flovent MDI, Intal MDI, Prednisone, Singulair chewable tablets, and other medications
- Allergy medications: Claritin liquid and reditabs, Nasonex, Zyrtec liquid
- Asthma breathing devices: Aerochamber, mask, Nebulizer and tubings, Nebulizer mask, peak flow meter, and others
- Other: Amoxicillin, flu shot, or other
Chart Audits. Under this program, CCHN also conducts manual chart audits on asthmatics ages 6-17. The asthma chart audit for Year 1 (Measurement Year: September 1, 2004- September 30, 2005) was completed in January 2006 with results reported to the clinics in April 2006. A total of 1,027 medical records at fifteen clinics and 35 sites were audited.
Key Measures included:
- Percent of documentation of the classification of asthma in the patient medical record according to National Institutes of Health (NIH) guidelines
- Percent of patients with persistent asthma who are prescribed controller medications
- Percent of asthma patients older than six years with a personal best peak flow recorded and/or personal peak flow goals identified documented in the measurement year
- Percent of asthma patients older than six years with a peak flow documented at the last asthma visit in the measurement year
- Percent of asthma patients who have an asthma action plan in the chart
- Percent of patients older than 6 months who receive an annual flu shot during the measurement year
- BMI Measured- BMI underweight, normal, at risk or overweight
Provider Roundtable. CCHN also facilitates the positive relationship between San Diego's community health centers and Kaiser Permanente, and has further enhanced that relationship by developing and conducting a Pediatric Asthma Roundtable. At the roundtable, community health center medical directors, asthma specialists, and Kaiser Permanente physicians with a focus on pediatric asthma, community health, or other related specialties, meet to share pediatric asthma best practices and lessons learned
Other Asthma Programs
The CCHN has a successful history of working with funders, clinics, and providers to ensure access to asthma services for uninsured patients. With previous funding from the American Lung Association and the California Department of Health Services, the CCHN established and maintained an Asthma Treatment Pool for asthma-related medical services for uninsured children from birth to five years of age with persistent asthma in 2001. This funding pool remained operable through 2004, and provided funding to treat approximately 300 children for asthma provider visits, medical procedures, asthma and allergy medications, and asthma breathing devices.
CCHN, in partnership with Children's Hospital and the American Lung Association of San Diego & Imperial Counties, obtained funding from the First 5 Commission of California to establish the San Diego Childhood Asthma Initiative (SDCAI) in the Mid-City and National City regions of San Diego County. SDCAI is a community collaborative designed to reduce the burden of asthma and improve the quality of life among children under the age of five with asthma and their families, by providing comprehensive asthma disease management. There are two primary components to the Initiative: Asthma Treatment Services (ATS) and Community Asthma Intervention (CAI). Together, these two components provide a multi-disciplinary team approach to asthma care coordination in collaboration with community partners.
CCHN is linked with additional asthma projects and coalitions in San Diego and across California to provide a comprehensive, community based approach to asthma management. CCHN staff and community partners are actively involved in the San Diego Regional Asthma Coalition activities including the Steering Committee and the Outreach and Education Committee. The CCHN, through the SDCAI, also partnered with the San Diego County Chapter of the American Academy of Pediatrics and received a grant from the County of San Diego Health and Human Services Agency to assist providers in implementing best practice standards for managing pediatric asthma. SDCAI staff is working closely with AAP staff to integrate this initiative with current SDCAI goals and activities.