Backman Desiree R, Kohatsu Neal D, Paciotti Brian M, Byrne Jennifer V, Kizer Kenneth W
California Department of Health Care Services, 1501 Capitol Ave, Ste 71.6129, MS 0000, PO Box 997413, Sacramento, CA 95899-7413. Email:
California Department of Health Care Services, Sacramento, California; Brian M. Paciotti, Optum Data Management, Sacramento, California, and California Department of Health Care Services, Sacramento, California.
Prev Chronic Dis. 2015 Nov 12;12:E196. doi: 10.5888/pcd12.150269.
Prevention is the most cost-effective approach to promote population health, yet little is known about the delivery of health promotion interventions in the nation's largest Medicaid program, Medi-Cal. The purpose of this study was to inventory health promotion interventions delivered through Medi-Cal Managed Care Plans; identify attributes of the interventions that plans judged to have the greatest impact on their members; and determine the extent to which the plans refer members to community assistance programs and sponsor health-promoting community activities.
The lead health educator from each managed care plan was asked to complete a 190-item online survey in January 2013; 20 of 21 managed care plans responded. Survey data on the health promotion interventions with the greatest impact were grouped according to intervention attributes and measures of effectiveness; quantitative data were analyzed using descriptive statistics.
Health promotion interventions judged to have the greatest impact on Medi-Cal members were delivered in various ways; educational materials, one-on-one education, and group classes were delivered most frequently. Behavior change, knowledge gain, and improved disease management were cited most often as measures of effectiveness. Across all interventions, median educational hours were limited (2.4 h), and median Medi-Cal member participation was low (265 members per intervention). Most interventions with greatest impact (120 of 137 [88%]) focused on tertiary prevention. There were mixed results in referring members to community assistance programs and investing in community activities.
Managed care plans have many opportunities to more effectively deliver health promotion interventions. Establishing measurable, evidence-based, consensus standards for such programs could facilitate improved delivery of these services.
预防是促进人群健康最具成本效益的方法，但对于在全国最大的医疗补助计划——加州医疗补助计划（Medi-Cal）中开展的健康促进干预措施，我们却知之甚少。本研究的目的是清点通过加州医疗补助计划管理式医疗计划提供的健康促进干预措施；确定那些被计划方认为对其成员影响最大的干预措施的属性；并确定计划方将成员转介至社区援助计划以及赞助促进健康的社区活动的程度。
2013年1月，要求每个管理式医疗计划的首席健康教育工作者完成一项包含190个项目的在线调查；21个管理式医疗计划中有20个做出了回应。关于影响最大的健康促进干预措施的调查数据，根据干预措施的属性和有效性指标进行了分组；定量数据采用描述性统计进行分析。
被认为对加州医疗补助计划成员影响最大的健康促进干预措施以多种方式提供；教育材料、一对一教育和小组课程最为常见。行为改变、知识获取和疾病管理改善最常被引为有效性指标。在所有干预措施中，教育时长中位数有限（2.4小时），加州医疗补助计划成员参与度中位数较低（每项干预措施265名成员）。大多数影响最大的干预措施（137项中的120项[88%]）侧重于三级预防。在将成员转介至社区援助计划和投资社区活动方面，结果不一。
管理式医疗计划有很多机会更有效地提供健康促进干预措施。为此类计划制定可衡量、基于证据的共识标准，有助于改善这些服务的提供。
