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Kaiser Permanente Of Colorado

Approximately 37,000 of Kaiser Permanente of Colorado’s (KPCO) members are diagnosed with asthma, of which 35 percent (13,000) have been diagnosed with persistent asthma, and about 65 percent with intermittent asthma.1 KPCO expanded its asthma care program from an asthma and diabetes care management pilot in 1997 after seeing a significant reduction in asthma hospitalization, emergency department (ED) acute visits for asthma and beta-agonist utilization among enrolled members within the first 6 months of the program.

Patient Identification

KPCO engages members into its asthma management program who have been diagnosed with asthma by a physician. Members with possible asthma but without an asthma diagnosis by a physician are engaged based on claims and pharmacy data.2 KPCO’s validated registry, HealthTrac, is updated every 24 hours from its electronic medical records (EMRs) and can be used at the regional, clinic and provider level to generate a comprehensive asthma report card with outcomes such as:

  • Beta-agonist overuse (BAO) by pharmacy data3
  • Hospitalization and emergency department utilization
  • Medication ratio
  • Population by age

KPCO’s disease management team is comprised of 9 registered nurses trained as asthma care coordinators. The team covers 25 clinics and roughly 640,000 members in the Denver/Boulder Colorado area. Most of the asthma care coordinators are also certified asthma educators. The team conducts telephonic outreach and clinic visits, which include assessment of asthma control, spirometry, and intensive education. The asthma care coordinators provide intensive asthma education and coordinate care with the patient’s primary care physician. They also conduct staff training on spirometry.

Engagement into the Program

Asthma care coordinators contact any patient that has been to the ED for asthma or COPD exacerbation as well as patients referred by providers for further education. The team may also contact asthma patients based on their asthma medication filling/refilling profile in the EMR. Kaiser is able to do this, reliably because most all members fill medications at a Kaiser Pharmacy.

Program Strategy

KPCO uses pharmacy-filling data to decrease the over-use of beta-agonists, which is an indication of asthma morbidity and mortality. The strategy involves the following two approaches:

Prevention Strategies

  • Outreach to patients who are not consistently filling controller medications or who are over-filling albuterol.4 Currently, a team of Pharmacists and Asthma Care Coordinators will use every albuterol refill request as a prompt to review a patient’s chart in the EMR for overuse of albuterol (albuterol filled < 3 months ago), under filling of controller medications or for those who do not have a diagnosis of asthma or COPD.
  • Encourage the use of Spirometry in primary care to better assess asthma severity and identify patients at risk
  • An Interactive Voice Response (IVR) system is also used to remind patients to fill their controller medications and to encourage medication adherence.

Care Management Strategies

  • Primary care physician follow-up within a week of any hospital visit.
  • Asthma care coordinators contact patients who have been to the ED (< 24 hour stay) and coordinate care with their primary care physician and/or allergist.
  • Allergists see all patients hospitalized for asthma (> 24 hour stay).

Outcomes

As a result of KPCO’s asthma care management efforts, the pediatric rates for ED visits, hospitalization and hospital readmissions were significantly lower than the national rates.

Outcomes Measured
(per 1000 patients)
KPCO National Rates
Hospitalizations 0.4 % 1.6 %
Readmissions 0 2.6 %**
ED Utilization Rate 1.73 % 2.6 %*
* National Health Statistics Report. Number 23. January 2011.
**JAMA 2013.3094(4):372-380

 


1Persistent and intermittent asthma are populated based on most recent of these two diagnosis used in an encounter.

2Patients with prescriptions of two or more beta-agonists (oral or inhaled) or one or more inhaled steroid, long-acting beta-agonist or theophylline within the last 12 months, or patients with at least 2 non-specified asthma prescriptions in the past 12 months or other lung disease diagnosis used to exclude patients.

3Overuse of beta-agonists is use of six or more beta-agonist canister equivalents within six months.

4BAO Metric: use of seven canister equivalents in 12 months.