Variability in asthma care and services for low-income populations among practice sites in managed Medicaid systems
Variability in asthma care and services for low-income populations among practice sites in managed Medicaid systems
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DOI：
10.1111/j.1475-6773.2003.00193.x
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发表时间：
2003-12-01
影响因子：
3.4
通讯作者：
Lieu, TA
中科院分区：
文献类型：
--
作者：
Lozano, P;Grothaus, LC;Lieu, TA
Objective.描述和描述参与医疗补助管理式护理（MMC）的实践点中为低收入人群量身定制的哮喘护理和服务过程的可变性。隶属于参与管理型医疗补助的五个非营利组织（三个团体模式健康维护组织[HMO]和两个医疗补助管理型医疗组织[MCO]）的八十五个实践站点。研究设计/数据收集。我们使用一个概念模型对管理式医疗实践网站的知情者进行了一次邮件调查，该模型包括针对低收入人群的慢性病护理和服务。调查询问了与哮喘护理相关的一些过程在实践场所发生的频率（从“从不”到“总是”）。我们报告平均值和标准差的项目得分和排名相对于其他项目。我们使用内MCO组内相关性，以评估如何一致的反应是在同一MCO的实践网站。与哮喘相关的护理过程在实践场所报告每日工作的频率方面差异很大，信息系统和自我管理支持服务排名最低。针对低收入人口的服务，特别是与文化多样性、沟通和增强登记者权能有关的服务的提供情况也有很大差异。很少的站点到站点的变化可归因于MCO。结论。我们的概念框架提供了一种评估为弱势群体提供慢性病护理的方法。在管理式医疗补助中，为儿童提供慢性哮喘护理还有改进的余地，特别是在自我管理支持和信息系统方面。在许多护理过程中，MCO内部缺乏一致性表明，护理可能更多地是在实践现场层面而不是MCO层面，这对质量改进工作产生了影响。
Objective. To characterize and describe variability in processes of asthma care and services tailored for low-income populations in practice sites participating in Medicaid managed care (MMC).Study Setting. Eighty-five practice sites affiliated with five not-for-profit organizations participating in managed Medicaid (three group-model health maintenance organizations [HMOs] and two Medicaid managed care organizations [MCOs]).Study Design/Data Collection. We conducted a mail survey of managed care practice site informants using a conceptual model that included chronic illness care and services targeting low-income populations. The survey asked how frequently a number of processes related to asthma care occurred at the practice sites (on a scale from "never" to "always"). We report mean and standard deviations of item scores and rankings relative to other items. We used within-MCO intraclass correlations to assess how consistent responses were among practice sites in the same MCO.Principal Findings. Processes of care related to asthma varied greatly in how often practice sites reported doing diem, with information systems and self-management support services ranking lowest. There was also significant variation in the availability of services targeting low-income populations, specifically relating to cultural diversity, communication, and enrollee empowerment. Very little of the site-to-site variation was attributable to the MCO.Conclusions. Our conceptual framework provides a means of assessing the provision of chronic illness care for vulnerable populations. There is room for improvement in provision of chronic asthma care for children in managed Medicaid, particularly in the areas of self-management support and information systems. The lack of consistency within MCOs on many processes of care suggests that care may be driven more at the practice site level than the MCO level, which has implications for quality improvement efforts.