Lozano Paula, Grothaus Lou C, Finkelstein Jonathan A, Hecht Julia, Farber Harold J, Lieu Tracy A
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA.
Health Serv Res. 2003 Dec;38(6 Pt 1):1563-78. doi: 10.1111/j.1475-6773.2003.00193.x.
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).
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.
Processes of care related to asthma varied gready in how often practice sites reported doing them, 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.
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.
在参与医疗补助管理式医疗（MMC）的实际场所中，对针对低收入人群的哮喘护理和服务流程的变异性进行特征描述。
八十五个实际场所隶属于五个参与管理式医疗补助的非营利组织（三个团体模式健康维护组织 [HMO] 和两个医疗补助管理式医疗组织 [MCO]）。
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际场所的信息提供者进行了邮件调查，该模型包括针对低收入人群的慢性病护理和服务。调查询问了一系列与哮喘护理相关的流程在实际场所发生的频率（从“从不”到“总是”）。我们报告了项目得分的均值和标准差以及相对于其他项目的排名。我们使用MCO内部类内相关系数来评估同一MCO内实际场所之间的回答一致性。
与哮喘相关的护理流程在实际场所报告执行的频率上差异很大，信息系统和自我管理支持服务排名最低。针对低收入人群的服务可用性也存在显著差异，特别是在文化多样性、沟通和参保者赋权方面。场所间的差异很少归因于MCO。
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方面仍有改进空间，特别是在自我管理支持和信息系统领域。MCO在许多护理流程上缺乏一致性表明，护理可能更多地由实际场所层面而非MCO层面驱动，这对质量改进工作具有影响。
