Tracy A. Lieu|Jonathan A. Finkelstein|Paula Lozano|Angela M. Capra|W. Felicia|Nancy G. Jensvold|Charles P. Quesenberry|Harold J. Farber
Cultural Competence Policies and Other Predictors of Asthma Care Quality for Medicaid-Insured Children
Harvard Pilgrim Health Care|Harvard University|Boston Children's Hospital|Harvard Pilgrim Health Care|Harvard University|Boston Children's Hospital|Group Health Cooperative|University of Washington|Kaiser Permanente|Kaiser Permanente|Kaiser Permanente|Kaiser Permanente|Kaiser Permanente Vallejo Medical Center
half medicaid enrollees managed care scant information exists policies practice sites improve quality care managed medicaid children asthma sentinel group medicaid quality monitoring elevated risk adverse outcomes objective study identify practicesite policies features associated quality care medicaidinsured children asthmaa prospective cohort study 1year followup conducted 5 health plans california washington massachusetts data collected via telephone interviews parents baseline 1 year surveys practice sites clinicians computerized databases practice site survey asked policies promote cultural competence use several types reports clinicians support selfmanagement asthma case management care coordination access continuity care quality care evaluated basis 5 measures 1 preventive medication underuse based parent report 2 parents rating asthma care 3 1year change childs asthma physical status based standardized measure 4 preventive medication underprescribing based computerized data 5 occurrence hospitalbased episodeof 1663 children study population 67 persistent asthma baseline based parent report symptoms medications 1year followup 65 children persistent asthma underusing preventive medication based parent report multivariate analyses patients practice sites highest cultural competence scores less likely underusing preventive asthma medications based parent report followup odds ratio 015 95 confidence interval ci 006041 highest vs lowest categories better parent ratings care use asthma reports clinicians predictive less preventive medication underprescribing based computerized data 033 95 ci 016069 better parent ratings care better asthma physical status followup patients practice sites policies promote access continuity less underuse preventive medications 056 95 ci 034093 among 83 practice sites practice sites size organizational type percentage patients insured medicaid mechanism payment specialty care primary care features consistently associated quality measurespracticesite policies promote cultural competence use reports clinicians access continuity predicted higher quality care children asthma managed medicaid