Rady Children’s Hospital–San Diego

Established in 1954, Rady Children’s Hospital–San Diego (RCHSD) has evolved from a 59-bed hospital for child polio victims to a 524-bed pediatric medical center servicing San Diego, Imperial and southern Riverside counties. Rady Children’s Health Network (RCHN) is a Clinically Integrated Network that combines primary care, specialty care and hospital-based services. In fiscal year 2019, more than 247,000 children relied on the hospital for care. Of this number, more than 55 percent of patients had Medi-Cal or no insurance. In 2019, RCHN had an asthma prevalence of 8.6 percent, while the Centers for Disease Control and Prevention’s 2018 asthma prevalence for children 18 and younger was reported at 7.5 percent and the California Department of Public Health’s 2014 prevalence was reported at 8.1 percent. Of the asthma population seen in the emergency department, the children are primarily Latinx (65%) and African American (12%). Many of the children live in neighborhoods commonly associated with inequalities related to poverty, air quality, and other socioeconomic and cultural factors. For the past 5 years, RCHSD has implemented a Community Approach to Severe Asthma Program, an innovative initiative utilizing a community health worker (CHW) model with the goal of improving management and outcomes for children with severe childhood asthma. CHWs contact the families and perform in-home visits to conduct environmental assessments, reinforce health care provider instructions, assess asthma control, and set behavioral and environmental change goals. Because of COVID -19, the team moved the home visit program to a completely virtual format with great success. Natural cleaning kits are distributed to all participants in the program, and home remediation supplies—such as dust mite encasings for beds, HEPA filters and closed lid garbage cans—are distributed as needed. The program has seen up to a 75 percent reduction in emergency department return rates for Medi-Cal patients and those with commercial insurance. Sustainability is achieved through a variety of mixed funding sources including grants, donations and a line item in the annual RCHSD budget. RCHSD also is advocating with legislators in the state of California to drive expanded reimbursement for in-home environmental care services, specifically for Medi-Cal health plans.