Laying the Foundation for Building a Resilient KPNC Community in the Face of Worsening Air Quality Due to Wildfire Smoke

Over the past decade, the frequency and impact of wildfires has steadily worsened across California, a trend that is expected to continue as climate change becomes an urgent, everyday reality. This means that the number of Kaiser Permanente Northern California (KPNC) members exposed to unhealthy air quality due to wildfire smoke will increase dramatically. Unsurprisingly, vulnerable patients are disproportionately impacted, such as those with chronic obstructive pulmonary disease (COPD). In this rigorous pilot, we will deploy a pilot in-home intervention to non-smoking, oxygen-dependent patients who have frequent exacerbations of COPD to mitigate their exposure to poor air quality and reduce exacerbations.

Inclusion criteria

• KPNC patients
• enrolled in Care Plus
• non-smoking
• oxygen-dependent
• adults aged ≥65 years old
• have had membership for at least 1 year prior to data extraction not counting </=3mo gaps)
• have known COPD (at least 2 encounters with COPD ICD codes over a 3 year period in the 10 years prior to data extraction using the following ICD codes: ICD-9 491.21, 491.22, 491.8, 491.9, 492.8, 493.2, 493.21, 493.22, 496 and ICD-10 J44.1, J44.0, J41.8, J44.9, J42)15
• have picked up at least 1 controller inhaler at the pharmacy within 1 year prior to data extraction
• at least 2 exacerbations of COPD treated in any setting (outpatient or acute care) within 1 year before to data extraction.

Exclusion criteria

• with <1 year of continuous membership prior to the date they entered the cohort, allowing for 3-month, non-contiguous gaps
• any diagnosis with any of the past or present problems: blindness, dementia, deaf or hearing impaired, hospice admission, "tracheostomy" procedure code or problems and/or attached to a ventilator
• hearing, visually, physically, memory, and/or speech impaired
• those on the "Do Not Call" list
• non-English speakers.