Q&A: Taking action ahead of wildfires to better serve patients with COPD, asthma

Key takeaways:

• Individuals at risk for poorer outcomes from wildfire smoke exposure may have a respiratory condition and/or a social risk factor.
• Identifying these patients is one of five steps in an action plan.

The University of California, Davis Health has established a population health-based action plan to help health systems and care teams stay on top of wildfires and protect patients with COPD and asthma, according to a press release.

This approach, published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, consists of five parts all centered around the goal of skillfully serving clinically high-risk and underserved populations in the face of more frequently occurring wildfires.

According to this perspective piece, the Wildfire Population Health Approach includes the following pillars:

1. “identify clinically at-risk and underserved patient populations using well-validated, condition-targeted registries;
2. assemble multidisciplinary care teams to understand the needs of these communities and patients;
3. create custom analytics and wildfire-risk stratification;
4. develop care pathways based on wildfire-risk tiers by disease, risk of exposure and health care access; and
5. identify outcome measures tailored to interventions with a commitment to continuous, iterative improvement effort.”

To learn more about the Wildfire Population Health Approach and how to adopt it into practice, Healio spoke with Reshma Gupta, MD, MSHPM, chief of population health and accountable care at University of California, Davis Health, and Brooks T. Kuhn, MD, MAS, co-director of the Comprehensive COPD Clinic and medical director of the department of respiratory care at University of California, Davis Health.

Healio: What inspired the creation of the five pillar Wildfire Population Health Approach?

Gupta: Our region of the country has been mired by wildfire smoke, and as health providers, we see our high-risk patients revolving through our clinic and hospital doors with difficulty breathing after exposure to wildfire smoke. Instead of solely dealing with the downstream effects of wildfires, we wanted to offer more support through symptom prevention and self-management. We were inspired by listening to our patients and their desires to be more proactive and empower them to care for themselves and their families at home. The population health approach helps us target our high-risk patients proactively and in real time with educational materials and toolkits to help them take care of themselves.

Healio: While practicing in Northern California, what are some negative health outcomes of wildfire smoke that you have seen in patients with COPD/asthma?

Brooks T. Kuhn

Kuhn: The Paradise Fire of 2018 was a seminal moment in the region. Many of our patients from that area felt the full ill-effects of a large wildfire: lack of resources/access to health care during the fire, loss of their homes and community, and significant impairment in breathing. Many of my patients in clinic still point to that event as a pivotal moment their COPD took a turn for the worse.

Healio: The first part of the approach involves finding populations who are at-risk and underserved. How do you recommend carrying out this task? Can these recommendations be used in other states?

Gupta: We approach identifying patients who are at-risk and underserved in two ways.

We define risk in a few different ways including clinical risk (eg, having a baseline respiratory condition) and social risk (eg, being homeless and exposed to smoke, having less access to insulated homes, air filters, etc). Through our population health team, we have curated our health system data into registries of patients with both respiratory conditions and social risk factors. We also use state and national data to identify which patients live in communities with lower access to resources through measures such as the healthy places index, which the state of California used during COVID outreach, and area deprivation index scores that work across national zip codes. These types of data points are accessible through the electronic health records in medical centers, and the social risk data is accessible and usually free across the country.

Healio: What are the benefits of putting together a multidisciplinary care team?

Gupta: Too often, we see health systems working in silos. Bridging teams means bridging expertise, knowledge and resources to expedite the development of a more nimble program. Integrating clinical, technology, environmental and community expertise is vital to create programs that will move the needle in empowering our patients and keeping them healthier.

Healio: Why should clinicians be familiar with the AirNow website when following the Wildfire Population Health Approach?

Kuhn: You cannot treat and manage what you cannot measure. While seeing large plumes of smoke is obvious, smaller particulate matter — PM_2.5 — is not always as easy to visualize. The approach we shared in our manuscript is a framework for health systems to help their communities identify high-risk patients dynamically with data, such as air quality data from AirNow.

Healio: You recommend that care teams “focus on interventions that provide patients with supplies, information, quality air filtration, transportation and proactive testing for underlying high-risk conditions.” How have these various items impacted high-risk and underserved populations? What changes have you noticed in patients?

Kuhn: We are currently studying this exact question! Guidelines that recommend running indoor AC units are not helpful if patients do not own one. Sheltering-in-home is not always a possibility when housing is unstable. We are performing a study assessing the impact of personalized education and home evaluation for patients in our high-risk COPD clinic. We have developed an approach where we try to meet the patient at their needs and their home.

Healio: How do you suggest health care teams get started on adopting this approach?

Gupta: The first step is bridging teams in your medical centers to identify your patients at most risk and leverage data. It is vital to prioritize this work and develop both the IT and care management infrastructure so the team can both identify the patients that may benefit the most quickly and deploy outreach rapidly.

We think it is vital for medical centers across the country to learn from health delivery systems and communities that have been facing wildfires for many years. This is a simple approach that can make impact by breaking down silos and getting started.

References:

• Kuhn BT, et al. Chronic Obstr Pulm Dis. 2024;doi:10.15326/jcopdf.2024.0509.
• People with COPD, asthma have higher risk of health problems from increased wildfire activity, smoke. https://www.copdfoundation.org/About-Us/Press-Room/Press-Releases/Article/2015/People-with-COPD-asthma-have-higher-risk-of-health-problems-from-increased-wild.aspx. Published Aug. 14, 2024. Accessed Aug. 14, 2024.