Written by: Center for Care Innovations

Dr. Gina Johnson of NEVHC with young patient, pre-COVID

Asthma is a complex, chronic, and costly disease that disproportionately impacts vulnerable children and communities of color. That’s not news to Northeast Valley Health Corporation, based in Los Angeles County, which serves low-income, mostly Latino patients in 15 health centers across the San Fernando and Santa Clarita Valleys.

The healthcare powerhouse — one of the nation’s largest community health centers — prides itself on the way its asthma care coordinators, educators, and providers work closely with their pediatric patients and their families to ensure that every child with asthma or asthma-like symptoms receives a health care treatment plan tailored to his or her needs. But despite the NEVHC’s care teams’ best efforts, all too frequently asthma patients land in the emergency department for non-emergency care.

The debilitating respiratory condition — which can flare up and trigger acute, worrisome breathing difficulties in young patients — can be tricky to manage and cause children and their concerned parents tremendous stress, discomfort, and pain.

Rosa Garcia, NEVHC asthma care coodinator, with patient (pre-COVID)

Asthma symptoms can spike at any time — including afterhours for medical clinics — often resulting in emergency department (ED) visits. “We teach our patients and their families self-management strategies to control their asthma and keep them out of the emergency room,” explains Rosa Garcia, lead asthma care coordinator at NEVHC. “We also inform our families that they can get advice from the provider on call whenever the health center is closed. However, some of our patients continue to use the emergency room for non-emergency care. After our follow-up phone calls, they realize that there are safe ways to control symptoms and avoid ED visits.”

These ED visits can be traumatic for patients and their families and cause preventable medical costs. Asthma is an expensive illness, totaling more than $50 billion a year in medical costs. The lung disorder accounts for 1.7 million ED visits a year, according to the Asthma and Allergy Foundation of America, making it one of the top 20 reasons for emergency room visits. On average, an asthma-related trip to the ED costs $1,502.

So keeping non-emergency asthma visits out of the ED is a genuine safety net clinic concern. It’s also easy to understand how patients end up there. NEVHC patients, like many others receiving Medi-Cal, may have had to deal with work, childcare, or transportation constraints that impacted their ability to make in-person primary care appointments for their children in pre-pandemic days, notes Debra Rosen, NEVHC’s director of quality and health education.

“For many of these patients, the ED was a one-stop shop where patients had 24/7 access to care without any financial deterrents or co-pays,” explains Rosen. That’s not the only reason so many pediatric asthma patients showed up in emergency departments before COVID-19 hit. “Our patients may not fully understand when to seek emergency care and the important benefits of continuity visits with their primary care provider. They also may not take advantage of after-hours telephone access to a NEVHC provider,” adds Rosen.

It’s a complicated problem. And NEVHC asthma care teams and their primary care physicians (PCPs) had long been in the dark about whether their asthma patients were presenting in emergency departments for true emergency treatment or simply routine care. Absent that information, there was understandable concern about a troubling lack of continuity of care, particularly with patients receiving non-emergency care at an emergency department visit.