Process of care for Medicaid-enrolled children with asthma: served by community health centers and other providers.
OBJECTIVE
To compare the process of care received by Medicaid-enrolled children with asthma served by community health centers (CHCs) and other Medicaid providers.


METHODS
Retrospective cohort study.


METHODS
Five provider types serving Massachusetts Medicaid enrollees: three provider groups--CHCs, hospital outpatient departments (OPDs), and solo/group physicians--participating in the statewide Primary Care Clinician Plan; a staff model health maintenance organization (HMO); and fee-for-service (FFS) providers.


METHODS
Six thousand three hundred twenty-one Medicaid-enrolled children (age 2-18) with asthma assigned to one of the above provider types in 1994.


METHODS
Person-level files were constructed by linking Medicaid claims, demographic and enrollment files with HMO encounter data.


METHODS
Five claims-based process of care measures reflecting aspects of care recommended in national guidelines were developed and used to analyze patterns of care across provider types, controlling for case-mix and other covariates.


RESULTS
Children served by CHCs and the HMO had significantly higher asthma visit rates compared with those served by OPDs, solo/group physicians and FFS providers. CHCs emergency department (ED) visit rates for asthma were lower than those of OPDs (P <0.001) and similar to other providers. However, CHC patients averaged more asthma hospitalizations relative to solo/group physicians or the HMO (P <0.0001). In multivariate analyses, children served by CHCs were 2.2 times as likely (95% CI, 1.02-4.91) as those served by solo/group physicians to receive a follow-up visit within 5 days of an asthma ED visit and 4.3 times as likely (95% CI, 1.45-12.68) to receive a follow-up visit within 5 days of hospital discharge. CHC patients with utilization suggestive of persistent asthma were less likely (OR, 0.28; 95% CI, 0.13-0.59) than those served by solo/group physicians to be seen by an asthma specialist. There were no significant differences in measures of asthma pharmacotherapy across providers types.


CONCLUSIONS
These data suggest that CHCs provide more timely follow-up care after an asthma ED visit or hospitalization relative to solo/group physicians, but diminished access to asthma specialists. There were no differences in asthma pharmacology across providers. Relatively low access to asthma specialists among children served by CHCs warrants further investigation.
Shields
Alexandra E
AE
Institute for Health Care Research and Policy, Georgetown Public Policy Institute, Georgetown University, 2233 Wisconsin Avenue NW, Suite 525, Washington, DC 20007, USA. shieldsa@georgetown.edu
Finkelstein
Jonathan A
JA
Comstock
Catherine
C
Weiss
Kevin B
KB
D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D015331:Cohort Studies; D003151:Community Health Centers / Q000592:standards*; D018588:Fee-for-Service Plans / Q000592:standards; D005260:Female; D006123:Group Practice / Q000592:standards; D006279:Health Maintenance Organizations / Q000592:standards; D006801:Humans; D008297:Male; D008404:Massachusetts; D008484:Medicaid / Q000592:standards*; D010044:Outpatient Clinics, Hospital / Q000592:standards; D011331:Private Practice / Q000592:standards; D017064:Process Assessment, Health Care; D012189:Retrospective Studies