Volume 3: No. 3, July 2006

ORIGINAL RESEARCH
Progress in Pediatric Asthma Surveillance I: The Application of Health Care Use Data in Alameda County, California

This figure is a spectrum or continuum that from the center to the right shows indicators of increasing quality of care and from the center to the left shows indicators of decreasing quality of care. The indicators of increasing quality of care are “Outpatient Visits,” “Symptom Medication Purchases,” and “Maintenance Medication Purchases.” The indicators of decreasing quality of care are “Emergency Department Visits,” “Hospitalizations,” and “Mortality.”

Figure 1. The spectrum of health care use indicators for asthma by quality of care.

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This figure shows administrative sources for health care billing records in Alameda County, Calif. The figure reads from top to bottom. Two boxes at the top of the figure each identify an administrative source: “Medi-Cal” and “Kaiser Permanente of Northern California.” The Medi-Cal box leads with arrows to two boxes below it, “Fee-for-Service” and “Managed Care.” The “Fee-for-Service” box leads with an arrow to a circle that contains the Patient Population in Person-Months, 221,318. The “Managed Care” box leads with arrows to two boxes, “Blue Cross of California” and “Alameda Alliance for Health.” The Blue Cross box leads with an arrow to a circle that contains Patient Population in Person-Months, 203,545; the Alameda Alliance box leads with an arrow to a circle that contains Patient Population in Person-Months, 498,176. The Kaiser Permanente box leads with an arrow to a circle that includes the Patient Population in Person-Months, 1,434,948. The circles indicating Kaiser Permanente and Alameda Alliance patient populations overlap, indicating that they have approximately 3.9% of the Kaiser Permanente patient population in common.

Figure 2. Administrative sources for health care billing records in Alameda County, California. Shaded circles indicate enrollee populations able to be included in the analysis because of completeness of records. Approximately 3.9% of Kaiser Permanente person-months represent Medi-Cal beneficiaries subcontracted through Alameda Alliance for Health.

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Figure 3. Hospitalization rates attributable to asthma (primary diagnosis only) among Medi-Cal beneficiaries during 2001 in Alameda County, California, by source of data. The Office of Statewide Healthcare Planning and Development (OSHPD) includes 100% of county residents receiving Medi-Cal benefits; the other three data sources include only their respective portions of this population. The OSHPD rate is calculated for children aged 0 to 14 years; all other rates are for children aged 0 to 17 years.

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This graph shows the distribution of the Kaiser Permanente of Northern California enrollee population by category of annual family income. The y axis is labeled “Percentage Living in Census Tract” and the x axis is labeled “Median Annual Family Income” divided into five categories: less than $30,000; $30,000–$49,000; $50,000–$69,000; $70,000–$90,000; and more than $90,000. The graph shows approximately 5% of the enrollee population in the less-than-$30,000 category; the graph peaks at approximately 34% in the $50,000–$69,000 category and decreases to approximately 15% in the more-than-$90,000 category. The figure also shows the income distribution of the general population for the county, which shows a similar pattern. Approximately 7% of the general population are in the less-than-$30,000 category; the graph peaks at approximately 30% in the $50,000–$69,000 category and decreases to approximately 17% in the more-than-$90,000 category. The enrollee population shows high congruence with the general population of the county, although it slightly underrepresents populations in the lowest and highest income categories and overrepresents those in the middle category.

Figure 4. Population representation of Kaiser Permanente of Northern California enrollee population, Alameda County, California, 2001.

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