Factors Influencing Patient Satisfaction With Care and Surgical Outcomes for Total Hip and Knee Replacement.

INTRODUCTION: Although patient satisfaction with total joint arthroplasty has been a well-measured outcome, little is known about how preadmission and post-discharge care experiences affect patients' rating of satisfaction. OBJECTIVE: This work aimed to identify actionable factors associated with better ratings of overall care and surgical results. METHODS: A 36-item survey assessing care in the preoperative, perioperative, and post-discharge phases of care and across all phases was mailed to 7,031 patients who underwent primary unilateral elective total hip arthroplasty and total knee arthroplasty in 2018. Exploratory factor analysis identified 7 actionable domains. Stepwise logistic regression models identified domains associated with ratings of overall care and satisfaction with surgical outcome. RESULTS: Of the 3,026 (43%) patients who returned the survey; 2,814 (93%) rated their overall experience of care as very good or excellent and satisfaction with surgical results as ≥ 7 on a 10-point scale. In exploratory factor analysis, four factors predicted higher ratings of both overall care and surgical outcome: knowing what to do with symptoms and pain during recovery (factor 1), self-reported health (factor 3), knowing what to expect before surgery (factor 4), and shared decision making (factor 6). Coordinated information among providers (factor 2), home health experience (factor 5), and patient-provider relationships (factor 7) also predicted overall care ratings. CONCLUSION: Patient-centered quality improvement in total joint replacement care requires thinking of care across the entire episode, including before and after the hospital stay for surgery, in addition to perioperative care. The actionable factors identified from this study can be incorporated into total joint replacement care to improve patients' satisfaction with overall care and surgical results.

Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study.

OBJECTIVE: To understand the epidemiology and burden of severe coronavirus disease 2019 (covid-19) during the first epidemic wave on the west coast of the United States. DESIGN: Prospective cohort study. SETTING: Kaiser Permanente integrated healthcare delivery systems serving populations in northern California, southern California, and Washington state. PARTICIPANTS: 1840 people with a first acute hospital admission for confirmed covid-19 by 22 April 2020, among 9 596 321 healthcare plan enrollees. Analyses of hospital length of stay and clinical outcomes included 1328 people admitted by 9 April 2020 (534 in northern California, 711 in southern California, and 83 in Washington). MAIN OUTCOME MEASURES: Cumulative incidence of first acute hospital admission for confirmed covid-19, and subsequent probabilities of admission to an intensive care unit (ICU) and mortality, as well as duration of hospital stay and ICU stay. The effective reproduction number (RE ) describing transmission dynamics was estimated for each region. RESULTS: As of 22 April 2020, cumulative incidences of a first acute hospital admission for covid-19 were 15.6 per 100 000 cohort members in northern California, 23.3 per 100 000 in southern California, and 14.7 per 100 000 in Washington. Accounting for censoring of incomplete hospital stays among those admitted by 9 April 2020, the estimated median duration of stay among survivors was 9.3 days (with 95% staying 0.8 to 32.9 days) and among non-survivors was 12.7 days (1.6 to 37.7 days). The censoring adjusted probability of ICU admission for male patients was 48.5% (95% confidence interval 41.8% to 56.3%) and for female patients was 32.0% (26.6% to 38.4%). For patients requiring critical care, the median duration of ICU stay was 10.6 days (with 95% staying 1.3 to 30.8 days). The censoring adjusted case fatality ratio was 23.5% (95% confidence interval 19.6% to 28.2%) among male inpatients and 14.9% (11.8% to 18.6%) among female inpatients; mortality risk increased with age for both male and female patients. Reductions in RE were identified over the study period within each region. CONCLUSIONS: Among residents of California and Washington state enrolled in Kaiser Permanente healthcare plans who were admitted to hospital with covid-19, the probabilities of ICU admission, of long hospital stay, and of mortality were identified to be high. Incidence rates of new hospital admissions have stabilized or declined in conjunction with implementation of social distancing interventions.

Assessing End-of-Life Care across Settings in an Integrated Health Care Delivery System.

Objective: To systematically capture patient- and family-centered data to understand variability and opportunities in end-of-life care delivery across settings in an integrated health care delivery system. Background: Improving the quality of end-of-life care requires assessing patient and family experiences across settings where care occurs, but we found no existing instrument suitable for this purpose. Methods: We conducted a cross-sectional survey with 10,308 surviving respondents (usually next of kin) of decedents in five Kaiser Permanente operating regions. The survey included eight items from an existing validated survey and three original items. Results: The overall response rate was 26% (2631). Most respondents reported that they were knowledgeable about decedents' end-of-life care and preferences. Across regions, 80% of respondents reported overall end-of-life care as excellent or very good. The proportion of excellent and very good responses was 74-84% across regions for items assessing attributes of end-of-life care, with statistically significant differences (p < 0.05). The proportion of positive responses was 69-89%. Overall, end-of-life care was rated as excellent or very good for a greater proportion of patients who received palliative care, hospice care, or both (78-82%), compared to those who did not (69%, p < 0.05 for all). Discussion: Regions are using data to inform end-of-life care initiatives. Assessing patient and family experiences of end-of-life care across settings with a single survey was feasible and provided valuable information supporting quality improvement. The survey met our need for a general purpose survey on end-of-life care experience.

Perceptions and Experience of Patients, Staff, and Clinicians with Social Needs Assessment.

CONTEXT: Assessment of social needs is expanding at Kaiser Permanente (KP), but little is known about how members and clinicians experience the incorporation of social needs into health care. OBJECTIVE: To assess how KP members and clinicians experience social needs assessments incorporated into care. DESIGN: Qualitative and descriptive analysis of data from member and clinician focus groups, interviews, and surveys among 68 members and family caregivers who had participated in social needs assessment programs and 90 clinicians and staff in the KP Colorado, Georgia, Northern California, Northwest, and Southern California Regions. MAIN OUTCOME MEASURES: Members' and clinicians' perceptions and experiences of social needs assessment. RESULTS: Members and clinicians understood the impact of social needs on health and why a health care system representative would ask about food, housing, transportation, and other social needs. Members and clinicians supported social needs assessment at KP and agreed that KP should help address identified social needs. However, both groups emphasized the importance of assessments yielding actionable information. Members were also concerned about how the information would be used and by whom. CONCLUSION: Our findings support the continuing assessment of social needs at KP and identify issues that require attention as it expands. Assessment should not outpace organizational capacity to connect members with resources. Careful attention to communications is required because members may be uncertain or concerned about the purpose of the assessment and the dissemination of sensitive information. Messaging should assure members about data use and dissemination and what they can expect after screening.

The impact of electronic health records and teamwork on diabetes care quality.

OBJECTIVES: Evidence of the impact electronic health records (EHRs) have on clinical outcomes remains mixed. The impact of EHRs likely depends on the organizational context in which they are used. This study focuses on one aspect of the organizational context: cohesion of primary care teams. We examined whether team cohesion among primary care team members changed the association between EHR use and changes in clinical outcomes for patients with diabetes. STUDY DESIGN: Retrospective longitudinal study. METHODS: We combined provider-reported primary care team cohesion with lab values for patients with diabetes collected during the staggered EHR implementation (2005-2009). We used multivariate regression models with patient-level fixed effects to assess whether team cohesion levels changed the association between outpatient EHR use and clinical outcomes for patients with diabetes. Subjects were comprised of 80,611 patients with diabetes, in whom we measured changes in glycated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C). RESULTS: For A1C, EHR use was associated with an average decrease of 0.11% for patients with higher-cohesion primary care teams compared with a decrease of 0.08% for patients with lower-cohesion teams (difference = 0.02% in A1C; 95% CI, 0.01%-0.03%). For LDL-C, EHR use was associated with a decrease of 2.15 mg/dL for patients with higher-cohesion primary care teams compared with a decrease of 1.42 mg/dL for patients with lower-cohesion teams (difference = 0.73 mg/dL; 95% CI, 0.41-1.11 mg/dL). CONCLUSIONS: Patients cared for by higher cohesion primary care teams experienced modest but statistically significantly greater EHR-related health outcome improvements, compared with patients cared for by providers practicing in lower cohesion teams.

Association of patient-reported care coordination with patient satisfaction.

Little is known about the relationship between care coordination directly assessed from the patient's perspective and patient satisfaction. This study applied multiple logistic regression models to examine associations between patient-reported care coordination and patient satisfaction among 1367 patients with diabetes. We found robust positive relationship between care coordination and patient satisfaction with overall chronic care (odds ratio [OR] = 1.78), one's regular doctor (OR = 1.85), and the way care was organized (OR = 1.98). Implications for health plans, providers, and future research are discussed.

The next step towards making use meaningful: electronic information exchange and care coordination across clinicians and delivery sites.

BACKGROUND: Care for patients with chronic conditions often requires coordination between multiple physicians and delivery sites. Electronic Health Record (EHR) use could improve care quality and efficiency in part by facilitating care coordination. OBJECTIVE: We examined the association between EHR use and clinician perceptions of care coordination for patients transferred across clinicians and delivery sites. RESEARCH DESIGN: Repeated surveys of primary care clinicians during the staggered implementation of an outpatient EHR (2005-2008), followed by an integrated inpatient EHR (2006-2010). We measured the association between EHR use stages (no use, outpatient EHR only, and integrated inpatient-outpatient EHR) and care coordination using logistic regression, adjusting for clinician characteristics, study year, and medical center. SUBJECTS: Adult primary care clinicians in a large Integrated Delivery System. MEASURES: Three measures of clinician-reported care coordination for patient care transferred across clinicians (eg, from specialist to primary care team) and across delivery sites (eg, from the hospital to outpatient care). RESULTS: Outpatient EHR use was associated with higher reports of access to complete and timely clinical information and higher agreement on clinician roles and responsibilities for patients transferred across clinicians, but not for patients transferred across delivery sites. Use of the integrated outpatient-inpatient EHR was associated with higher reports of access to timely and complete clinical information, clinician agreement on the patient's treatment plan for patients transferred across delivery sites, and with all coordination measures for patients transferred across clinicians. CONCLUSION: Use of an integrated EHR with health information exchange across delivery settings improved patient care coordination.

Manual and automated methods for identifying potentially preventable readmissions: a comparison in a large healthcare system.

BACKGROUND: Identification of potentially preventable readmissions is typically accomplished through manual review or automated classification. Little is known about the concordance of these methods. METHODS: We manually reviewed 459 30-day, all-cause readmissions at 18 Kaiser Permanente Northern California hospitals, determining potential preventability through a four-step manual review process that included a chart review tool, interviews with patients, their families, and treating providers, and nurse reviewer and physician evaluation of findings and determination of preventability on a five-point scale. We reassessed the same readmissions with 3 M's Potentially Preventable Readmission (PPR) software. We examined between-method agreement and the specificity and sensitivity of the PPR software using manual review as the reference. RESULTS: Automated classification and manual review respectively identified 78% (358) and 47% (227) of readmissions as potentially preventable. Overall, the methods agreed about the preventability of 56% (258) of readmissions. Using manual review as the reference, the sensitivity of PPR was 85% and specificity was 28%. CONCLUSIONS: Concordance between methods was not high enough to replace manual review with automated classification as the primary method of identifying preventable 30-day, all-cause readmission for quality improvement purposes.

Person-focused care at Kaiser Permanente.

Patient-focused care has been described as an extension of patient-centered care, recognizing that patients' medical needs are best understood and addressed in the context of their entire lives, including their life goals and social, economic, emotional, and spiritual functioning. Kaiser Permanente is expanding its ability to care for members as whole persons, not just as patients, with sensitivity to nonmedical factors in planning and delivering care. We describe emerging examples in several areas: interdisciplinary care planning, behavior change, social care, patient-reported outcome measures, and Total Health. Realizing the vision of person-focused care requires taking every opportunity to fully recognizing that each patient we serve is first and foremost a person.

The association between EHRs and care coordination varies by team cohesion.

OBJECTIVE: To examine whether primary care team cohesion changes the association between using an integrated outpatient-inpatient electronic health record (EHR) and clinician-rated care coordination across delivery sites. STUDY DESIGN: Self-administered surveys of primary care clinicians in a large integrated delivery system, collected in 2005 (N=565), 2006 (N=678), and 2008 (N=626) during the staggered implementation of an integrated EHR (2005-2010), including validated questions on team cohesion. Using multivariable regression, we examined the combined effect of EHR use and team cohesion on three dimensions of care coordination across delivery sites: access to timely and complete information, treatment agreement, and responsibility agreement. PRINCIPAL FINDINGS: Among clinicians working in teams with higher cohesion, EHR use was associated with significant improvements in reported access to timely and complete information (53.5 percent with EHR vs. 37.6 percent without integrated-EHR), agreement on treatment goals (64.3 percent vs. 50.6 percent), and agreement on responsibilities (63.9 percent vs. 55.2 percent, all p<.05). We found no statistically significant association between use of the integrated-EHR and reported care coordination in less cohesive teams. CONCLUSION: The association between EHR use and reported care coordination varied by level of team cohesion. EHRs may not improve care coordination in less cohesive teams.

Use of IndiGO individualized clinical guidelines in primary care.

OBJECTIVE: To determine if IndiGO individualized clinical guidelines could be implemented in routine practice and assess their effects on care and care experience. METHODS: Matched comparison observational design. IndiGO individualized guidelines, based on a biomathematical simulation model, were used in shared decision-making. Physicians and patients viewed risk estimates and tailored recommendations in a dynamic user interface and discussed them for 5-10 min. Outcome measures were prescribing and dispensing of IndiGO-recommended medications, changes in physiological markers and predicted 5-year risk of heart attack and stroke, and physician and patient perceptions. RESULTS: 489 patients using IndiGO were 4.9 times more likely to receive a statin prescription than were matched usual care controls (p=0.015). No effect was observed on prescribing of antihypertensive medications, but IndiGO-using patients were more likely to pick up at least one dispensing (p<0.05). No significant changes were observed in blood pressure or serum lipid levels. Predicted risk of heart attack or stroke decreased 1.6% among patients using IndiGO versus 1.0% among matched controls (p<0.01). Physician and patient experiences were positive to neutral. LIMITATIONS: We could not assess the separate effects of individualized guidelines, user interface, and physician-patient discussions. Patient selection could have influenced results. The measure of risk reduction was not independent of the individualized guidelines. CONCLUSIONS: IndiGO individualized clinical guidelines were successfully implemented in primary care and were associated with increases in the use of cardioprotective medications and reduction in the predicted risk of adverse events, suggesting that a larger trial could be warranted.

Complete care at Kaiser Permanente: transforming chronic and preventive care.

BACKGROUND: In 2004 Kaiser Permanente Southern California (KPSC) recognized the potential to improve the quality of care. Healthcare Effectiveness Data and Information Set (HEDIS) performance was below what regional leadership aspired to achieve, exceeding the 90th national percentile on only 15 of 34 measures. Beginning in 2005 regional leadership identified several system opportunities to enhance evidence-based, person-focused care. DEVELOPMENT OF COMPLETE CARE: KPSC developed and implemented a comprehensive delivery system redesign and expanded and integrated existing clinical information systems, decision support, work flows, and self-management support-collectively referred to as Complete Care. The goal of Complete Care is to transform care for healthy members, those with chronic conditions, and those with multiple comorbidities. To date, KPSC has applied Complete Care to 26 chronic conditions and areas of preventive and wellness care. Implemented in all care settings and optimizing the roles of all health care team members to maximal scope of practice, Complete Care provides evidence-based, person-focused care addressing a large set of protocol-based health needs for every individual during every encounter within the health care system. RESULTS: On 51 HEDIS metrics, KPSC improvement using Complete Care averaged 13.0%, compared with 5.5% improvement in the national HEDIS 50th percentile. CONCLUSION: Implementation of Complete Care at KPSC was followed by six-year quality gains that outpaced changes in the HEDIS national percentiles for many measures. Additional care gaps have been included in proactive office encounter checklists; these relate to elder care, advance directives, posthospital care, immunizations, health maintenance, and pregnancy care.

How Kaiser Permanente uses video ethnography of patients for quality improvement, such as in shaping better care transitions.

Keeping patients and caregivers at the center of quality improvement is critical. Kaiser Permanente's Care Management Institute adapted video ethnography to achieve this aim, using video to capture interviews with-and observations of-patients and caregivers, identify patient-centered improvement opportunities, and communicate them effectively to clinical and administrative leaders and front-line staff. This method is particularly effective for helping understand the needs of frail elders, patients nearing the end of life, those with multiple chronic conditions, and other vulnerable people who are not well represented in focus groups and patient advisory councils. As part of an initiative to improve care transitions for elders with heart failure, video ethnography contributed to greatly reduced thirty-day hospital readmission rates, helping reduce readmissions at one medical center from 13.6 percent to 9 percent in six months. It also helped improve the reliability of the readmissions reduction program. When embedded within an established quality improvement framework, video ethnography can be an effective tool for innovating new solutions, improving existing processes, and spreading knowledge about how best to meet patient needs.

Self-management support to people with type 2 diabetes - a comparative study of Kaiser Permanente and the Danish Healthcare System.

BACKGROUND: Self-management support is considered to be an essential part of diabetes care. However, the implementation of self-management support within healthcare settings has appeared to be challenging and there is increased interest in "real world" best practice examples to guide policy efforts. In order to explore how different approaches to diabetes care and differences in management structure influence the provision of SMS we selected two healthcare systems that have shown to be comparable in terms of budget, benefits and entitlements. We compared the extent of SMS provided and the self-management behaviors of people living with diabetes in Kaiser Permanente (KP) and the Danish Healthcare System (DHS). METHODS: Self-administered questionnaires were used to collect data from a random sample of 2,536 individuals with DM from KP and the DHS in 2006-2007 to compare the level of SMS provided in the two systems and identify disparities associated with educational attainment. The response rates were 75 % in the DHS and 56 % in KP. After adjusting for gender, age, educational level, and HbA1c level, multiple linear regression analyses determined the level of SMS provided and identified disparities associated with educational attainment. RESULTS: Receipt of SMS varied substantially between the two systems. More people with diabetes in KP reported receiving all types of SMS and use of SMS tools compared to the DHS (p < .0001). Less than half of all respondents reported taking diabetes medication as prescribed and following national guidelines for exercise. CONCLUSIONS: Despite better SMS support in KP compared to the DHS, self-management remains an under-supported area of care for people receiving care for diabetes in the two health systems. Our study thereby suggests opportunity for improvements especially within the Danish healthcare system and systems adopting similar SMS support strategies.

Patient experiences of transitioning from hospital to home: an ethnographic quality improvement project.

BACKGROUND: Little is known about patient perspectives of the transition from hospital to home. OBJECTIVE: To develop a richly detailed, patient-centered view of patient and caregiver needs in the hospital-to-home transition. DESIGN: An ethnographic approach including participant observation and in-depth, semi-structured video recorded interviews. SETTING: Kaiser Permanente's Southern California, Colorado, and Hawaii regions. PATIENTS: Twenty-four adult inpatients hospitalized for a range of acute and chronic conditions and characterized by variety in diagnoses, illness severity, planned or unplanned hospitalization, age, and ability to self manage. RESULTS: During the hospital-to-home transition, patients and caregivers expressed or demonstrated experiences in 6 domains: 1) translating knowledge into safe, health-promoting actions at home; 2) inclusion of caregivers at every step of the transition process; 3) having readily available problem-solving resources; 4) feeling connected to and trusting providers; 5) transitioning from illness-defined experience to "normal" life; and 6) anticipating needs after discharge and making arrangements to meet them. The work of transitioning occurs for patients and caregivers in the hours and days after they return home and is fraught with challenges. CONCLUSIONS: Reducing readmissions will remain challenging without a broadened understanding of the types of support and coaching patients need after discharge. We are piloting strategies such as risk stratification and tailoring of care, a specialized phone number for recently discharged patients, standardized same-day discharge summaries to primary care providers, medication reconciliation, follow-up phone calls, and scheduling appointments before discharge.

Factors contributing to all-cause 30-day readmissions: a structured case series across 18 hospitals.

OBJECTIVE: To understand factors leading to all-cause 30-day readmissions in a community hospital population. RESEARCH DESIGN: Structured case series of 537 readmissions using chart reviews, interviews with treating physicians, patients and family caregivers, and overall case assessment by a nurse-physician team. SETTING: Eighteen Kaiser Permanente Northern California hospitals. RESULTS: Forty-seven percent (250) of readmissions were assessed as potentially preventable; 11% (55) were assessed as very or completely preventable; and 36% (195) as slightly or moderately preventable. On average, 8.7 factors contributed to each potentially preventable readmission. Factors were related to care during the index stay (in 143 cases, 57% of potentially preventable readmissions), the discharge process (168, 67%), and follow-up care (197, 79%). Missed opportunities to prevent readmissions were also related to quality improvement focus areas: transitions care planning and care coordination, clinical care, logistics of follow-up care, advance care planning and end-of-life care, and medication management. CONCLUSIONS: Multiple factors contributed to potentially preventable readmissions in an integrated health care system with low baseline readmission rates. Reducing all-cause 30-day readmissions may require a comprehensive approach addressing these areas. Future quality improvement efforts and research should identify existing and new tactics that can best prevent readmissions by addressing missed opportunities we identified.

Effective population management practices in diabetes care - an observational study.

BACKGROUND: Ensuring that evidence based medicine reaches patients with diabetes in the US and internationally is challenging. The chronic care model includes evidence based management practices which support evidence based care. However, despite numerous studies, it is unclear which practices are most effective. Few studies assess the effect of simultaneous practices implemented to varying degrees. The present study evaluates the effect of fifteen practices applied concurrently and takes variation in implementation levels into account while assessing the impact of diabetes care management practices on glycemic and lipid monitoring. METHODS: Fifteen management practices were identified. Implementation levels of the practices in 41 medical centres caring for 553,556 adults with diabetes were assessed from structured interviews with key informants. Stepwise logistic regression models with management practices as explanatory variables and glycemic and lipid monitoring as outcome variables were used to identify the diabetes care practices most associated with high performance. RESULTS: Of the 15 practices studied, only provider alerts were significantly associated with higher glycemic and lipid monitoring rates. The odds ratio for glycemic monitoring was 4.07 (p < 0.00001); the odds ratio for lipid monitoring was 1.63 (p < 0.006). Weaker associations were found between action plans and glycemic monitoring (odds ratio = 1.44; p < 0.03) and between guideline distribution and training and lipid monitoring (odds ratio = 1.46; p < 0.03). The covariates of gender, age, cardiac disease and depression significantly affected monitoring rates. CONCLUSIONS: Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training. Lack of convergence in the literature on effective care management practices suggests that factors contributing to high performance may be highly context-dependent or that the factors involved may be too numerous or their implementation too nuanced to be reliably identified in observational studies.

Is the Kaiser Permanente model superior in terms of clinical integration?: a comparative study of Kaiser Permanente, Northern California and the Danish healthcare system.

BACKGROUND: Integration of medical care across clinicians and settings could enhance the quality of care for patients. To date, there is limited data on the levels of integration in practice. Our objective was to compare primary care clinicians' perceptions of clinical integration and three sub-aspects in two healthcare systems: Kaiser Permanente, Northern California (KPNC) and the Danish healthcare system (DHS). Further, we examined the associations between specific organizational factors and clinical integration within each system. METHODS: Comparable questionnaires were sent to a random sample of primary care clinicians in KPNC (n = 1103) and general practitioners in DHS (n = 700). Data were analysed using multiple logistic regression models. RESULTS: More clinicians in KPNC perceived to be part of a clinical integrated environment than did general practitioners in the DHS (OR = 3.06, 95% CI: 2.28, 4.12). Further, more KPNC clinicians reported timeliness of information transfer (OR = 2.25, 95% CI: 1.62, 3.13), agreement on roles and responsibilities (OR = 1.79, 95% CI: 1.30, 2.47) and established coordination mechanisms in place to ensure effective handoffs (OR = 6.80, 95% CI: 4.60, 10.06). None of the considered organizational factors in the sub-country analysis explained a substantial proportion of the variation in clinical integration. CONCLUSIONS: More primary care clinicians in KPNC reported clinical integration than did general practitioners in the DHS. Focused measures of clinical integration are needed to develop the field of clinical integration and to create the scientific foundation to guide managers searching for evidence based approaches.

Medication use, emergency hospital care utilization, and quality-of-life outcome disparities by race/ethnicity among adults with asthma.

OBJECTIVES: To examine the association of race/ethnicity with medication use, emergency hospital care (EHC) utilization, and quality-of-life outcomes in a population with persistent asthma and to determine if factors related to severity of illness, treatment characteristics, and demographic, socioeconomic, and smoking status explain differences in study outcomes. STUDY DESIGN: Retrospective analysis. METHODS: We examined survey and administrative data for 974 adults with persistent asthma enrolled in a group-model health maintenance organization. Patients with persistent asthma were identified in 1999 using Healthcare Effectiveness Data and Information Set inclusion criteria. In 2000, the same patients were surveyed regarding quality of life using the Mini Asthma Quality of Life Questionnaire. In 2001, the use of controller medications, the ratio of controller medications to rescue medications, and EHC utilization were identified by electronic medical record. Multiple logistic regression and linear regression analyses were used to evaluate the independent association of race/ethnicity with study outcomes after adjusting for severity of illness, treatment characteristics, and demographic, socioeconomic, and smoking status. RESULTS: Compared with whites, African Americans (standardized ß coefficient, -0.12) and Native Americans/Aleutians/Eskimos (standardized ß coefficient, -0.14) had lower Mini Asthma Quality of Life Questionnaire scores (P <.05 for both). African Americans were significantly (P <.05) more likely to report EHC utilization (odds ratio, 5.2; 95% confidence interval, 2.6-10.3). CONCLUSIONS: Disparities existed in 2 outcome measures, Mini Asthma Quality of Life Questionnaire scores and EHC utilization. A concerning finding is that African Americans were at least 5 times more likely to report higher EHC utilization, even after adjusting for factors such as income and education.