Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees
| Autor: | Elizabeth Shenkman, Kimberly Case, Matthew F. Van Voorhis, Garth N. Graham, Jason A. Lee, Jill Boylston Herndon, W. Bruce Vogel, Keith E. Muller, Martin P. Wegman |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Program evaluation medicine.medical_specialty Primary health care Article Humans Medicine Disabled Persons Quality of care Quality of Health Care Primary Health Care Medicaid Rapid expansion business.industry Managed Care Programs Public Health Environmental and Occupational Health Health services research Middle Aged Case management Texas Waiver United States Family medicine Chronic Disease Female Health Services Research business Case Management Program Evaluation |
| Zdroj: | Medical Care. 53:599-606 |
| ISSN: | 0025-7079 |
| DOI: | 10.1097/mlr.0000000000000371 |
| Popis: | Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.Person-level claims and encounter data for 2006-2010 were used to compute adherence to 6 quality measures. With county as the independent sampling unit, we employed a longitudinal linear mixed-model analysis accounting for administrative clustering and geographic and individual factors.Although quality was similar among programs at baseline, STAR+PLUS enrollees experienced large and sustained improvements in use of β-blockers after discharge for heart attack (49% vs. 81% adherence posttransition; P0.01) and appropriate use of systemic corticosteroids and bronchodilators after a chronic obstructive pulmonary disease event (39% vs. 68% adherence posttransition; P0.0001) compared with FFS/PCCM enrollees. No statistically significant effects were identified for quality measures for asthma, diabetes, or cardiovascular disease.In 1 large Medicaid-managed care HCBS program, the quality of chronic disease care linked to acute events improved while that provided during routine encounters appeared unaffected. |
| Databáze: | OpenAIRE |
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