Principal Investigators: Kenny Kwong (DHS), Paul Fu (UCLA/Harbor) UCLA CTSI-Los Angeles County Department of Health Services (DHS) Projects Asthmatic children with frequent asthma exacerbations require preventative long term care to reduce morbidity, yet many of these patients belong to community health care organizations (HMOs) without a network/contracted pediatric emergency department (PED). This may result in no transition from costly acute to cost effective preventative care, poor disease control and leading patients to use the PED in “revolving door” fashion. It is unclear whether lack of transition from acute to chronic asthma care occurs between the PED at Harbor-UCLA Medical Center (HUMC) and out of network community HMOs and whether this leads to increased asthma morbidity. This current study compares pediatric asthma patients who receive regular asthma care at HUMC versus community HMOs with primary outcomes being asthma control, asthma PED visits, asthma hospitalizations, preventative provider visits and asthma controller prescriptions. Results will identify barriers to smooth transition of asthmatic care between 2 health care systems that can be targeted to improve care to asthmatic children.

1. PROSPECTIVE STUDY OF ASTHMA CONTROL, ASTHMA
MORBIDITY, QUALITY OF LIFE AND HEALTH CARE
EXPENDITURE IN ASTHMATIC CHILDREN DURING
TRANSITION FROM ACUTE CARE AT HARBOR‐UCLA MEDICAL
CENTER (HUMC) BACK TO COMMUNITY MANAGED CARE
ORGANIZATIONS
(Are we as competent as the community?)
Kenny Kwong M.D. Allergy‐Immunology
Paul Fu Jr. M.D. General and Emergency
Pediatrics
Harbor‐UCLA Medical Center

2. BACKGROUND
• Poor asthma control (symptoms) and morbidity (urgent care
visits and hosp.) has not significantly decreased in the
greater Los Angeles area DESPITE advances in asthma care
and treatment. In parAcular among minority inner city
children.
• AsthmaAc children in the South Bay area regularly use the
pediatric emergency (PED) department at HUMC for acute
care.
• It is unknown whether asthmaAc children belonging to
community managed care organizaAons who used HUMC
PED for acute care receive effecAve long term preventaAve
care for their asthma.

3. Harbor‐UCLA Pediatrics ED
Community managed care
Research QuesNon: Do asthmaNc children cared for by community HMO’s
receive less consistent long term preventaNve care compared to similar
patents managed byHUMC in a pediatric medical home? And therefore
use the PED at HUMC in a “revolving Door manner?”

4. Methods
Asthma pa2ents
Presen2ng to
HUMC PED
(12 month period)
3 month 3 month 3 month
Asthma control test (ACT)
Asthma quality of life (QOL)
ED visits
HospitalizaNons
HUMC care
Community HMO care
3 month 3 month 3 month 3 month
# asthma controllers
#asthma relievers
#asthma specific care provider visits
#asthma specialist visits
Asthma Control
Asthma morbidity
Health care
u2liza2on
Preventa2ve care
Telephone
Administered quesNonnaire
(100 paNents)
Mail out quesNonnaire
(all paNents)
3 month

5. HUMC care Community HMO care
Asthma control and morbidity
Asthma control
Asthma QOL
Asthma urgent care
Asthma hospitaliza2ons
PreventaNve asthma care
# asthma controllers
#asthma relievers
#asthma specific care provider visits
#asthma specialist visits
Asthma control and morbidity
Asthma control
Asthma QOL
Asthma urgent care
Asthma hospitaliza2ons
PreventaNve asthma care
# asthma controllers
#asthma relievers
#asthma specific care provider visits
#asthma specialist visits
VS
VS
Outcomes: 1. Asthma control and morbidity. 2. PreventaAve asthma care

6. Asthma pa2ents
Presen2ng to
HUMC PED
(12 month period)
3 month 3 month 3 month 3 month
HUMC care
Community HMO care
General Pediatrics clinic/provider visit (level 3, CPT 99213): $21.40
Asthma Specialist (Level 3 CPT: 99215): $57.20
General Pediatrics urgent care visit (Level 3 CPT 99243): $59.50
ED visit/DHS: $1500
Inpatient stay per day/DHS $3000
Asthma controllers and relievers Variable
Outcomes: Healthcare u2liza2on

7. CERP aims addressed
• Aim 4: Build health services research (HSR)
methods into partnerships to accelerate
design, produc2on and adop2on of evidence‐
based interven2ons.
• Aim 2: Build community and academic
infrastructure for sustainable partnered
research

8. Time line
Grant funded
IRB approved Study
coordinator
hired
Telephone
Pa2ent
Enrollment
Began
Mail out
Ques2onnaires
12 months
AWer
Ini2al
enrollments
Data analysis
7/25/13 7/17/13 5/6/13 8/5/13 8/5/14

9. Added value from CTSI funding
• Provided salary support of a ¼ FT research
associate who is coordina2ng telephone
interviews and mail out ques2onnaires.
• Provide sta2s2cal analysis when data is to be
analyzed.
• Bring to the aaen2on of HUMC/DHS
leadership importance of this area of HSR.

10. Data so far….

11. 0
20
40
60
80
100
120
ED visits
Unscheduled
urgent care
Hospitaliza2on
Regular
provider visit
Asthma
specialist visit
# rescue
inhalers
# controller
inhalers
Controller/
reliever ra2o
% paAents
Preliminary data: Acute care visits, hosp, regular care and asthma controller/reliever
prescrip2ons between HUMC and community HMO pa2ents –Telephone surveys
HUMC (n=28)
Community HMO (n=33)

12. 0
20
40
60
80
100
120
ED visits
Unscheduled
urgent care
Hospitaliza2on
Regular provider
visit
Asthma specialist
visit
# rescue inhalers
# controller
inhalers
Controller/reliever
ra2o
Preliminary data: Acute care visits, hosp, regular care and asthma controller/reliever
prescrip2ons between HUMC and community HMO pa2ents –Telephone surveys
HUMC (n=46)
Community HMO (n=52)

13. Plan #visits #pa2ents #frequency
1. LA CARE ‐ DHS ASSIGNED (SPD) 243 185 1.31
2. LA CARE ‐ NON‐DHS ASSIGNED (NON‐SPD) 355 314 1.13
3. MEDI‐CAL 289 232 1.25
4. SELF‐PAY 235 218 1.08
6. ORSA 2 2 1.00
7. OTHER 564 483 1.17
Frequency of ED visits of pediatric asthma paNents 10/2011 to 10/2012

14. Preliminary interpreta2ons
• There is no significant difference between asthma
care provided by HUMC versus community HMO.
• Community HMO managed asthma2cs have
slightly lower repeat ED visits at HUMC PED for
asthma
• There is significantly under‐prescrip2on of
asthma controller medica2ons in both HUMC and
community managed asthma children
• (Boaom line: we all do a terrible job)

15. Next steps and products
• DHS/HUMC‐community asthma provider network for
iden2fying high risk pa2ents, sharing of clinical data
and tracking of pa2ents on a recurring/long term basis;
•
• DHS/HUMC‐community pediatric asthma disease
management program to shiW expensive acute care to
cost effec2ve long term preventa2ve care;
• Development of private community managed care
contracts with DHS/HUMC specialty care to reduce
asthma burden and costs to their members.

16. Acknowledgements
• Jumie Lee PNP – HUMC PED
• Stanley Inkelis MD – HUMC PED
• Melody Casillas RN – Peds Allergy‐Immunology
• Johanna Raygoza – LA Biomed