Adolescent enrollees in Medicaid managed care: the provision of well care and sexual health assessment.
OBJECTIVE
(1) To estimate the proportion of adolescents receiving outpatient care, well care, and sexual health assessment during 12 months of continuous enrollment in Medicaid managed care. (2) To investigate factors associated with provision of these categories of service.


METHODS
Chart reviews were completed for a statewide random sample of adolescent Medicaid enrollees in Washington State. Multivariate logistic regression models included age, gender, race, language, residence, enrollment plan, and service level as independent variables. Dependent variables were receipt of outpatient care, well care, and sexual health assessment.


RESULTS
Of 2000 enrollees' records, 78.3% provided evidence of outpatient service, 30.5% included well care, and 20.8% documented a sexual health assessment. Among adolescents who obtained service, younger enrollees and non-Whites were more likely to receive well care; females, older enrollees, and those with well care were more likely to have sexual health assessments. Use of standardized charting tools increased the likelihood that sexual health assessments would be documented. The variable most strongly associated with provision of outpatient service was plan of enrollment. Plan rankings on provision of outpatient care were not associated with organizational descriptions, such as for-profit status or plan structure.


CONCLUSIONS
The low rates of well care and sexual health assessment documented for adolescents in Medicaid managed care suggest that interventions are needed.
Lafferty
W E
WE
University of Washington, Department of Health Services, Seattle, Washington 98195-7660, USA. billaf@u.washington.edu
Downey
L
L
Shields
A W
AW
Holan
C M
CM
Lind
A
A
D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D005260:Female; D006302:Health Services Research; D006305:Health Status Indicators; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D009922:Oregon; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D011314:Preventive Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D014600:Utilization Review; D014861:Washington / Q000453:epidemiology