Bethell C, Reuland CP, Abrams M; AcademyHealth. Meeting (2005 : Boston, Mass.).

Abstr AcademyHealth Meet. 2005; 22: abstract no. 4368.

Oregon Health & Science University, Department of Pediatrics , Mailcode CDRC-P 707 SW Gaines Street, Portland, OR 97239 Tel. 503-494-1892 Fax 503-494-2475

RESEARCH OBJECTIVE: To develop and assess the feasibility, value and findings from a collaborative and integrated consumer-centered model for measuring key aspects of EPSDT services for young children that are currently not validly assessed in most Medicaid programs. STUDY DESIGN: The parent-reported Promoting Healthy Development Survey-PLUS (PHDS-PLUS) was implemented across seven Medicaid programs to parents of children age 3-48 months of age. Eleven EPSDT related measures of care were constructed and these child-level survey findings were integrated with other child-level variables regarding program participation (Medicaid, SCHIP, Title V), care setting (FQHC, office), type of health care provider, organization of care (MCO, FFS, PCCM), utilization of well-child visits and other services. Four of these states implemented the survey through a single vendor contract using Federal matching funds as appropriate. State teams representing Medicaid, SCHIP, Title V and other state agencies were assembled in four of these states and facilitated using an online WebX system. These teams (1) developed state specific data collection strategies, (2) facilitated securing data needed for survey sampling and to construct non-survey variables (e.g. program participation, care setting, utilization) and (3) guided strategies to communicate findings in order to inform and stimulate efforts to improve policy and practice within Medicaid, among health care providers and other state agencies. Bivariate and multivariate analyses were conducted to assess variations and associations between performance measures and other variables within and across states. POPULATION STUDIED: Children age 3-48 months of age meeting sampling criteria for inclusion in the PHDS-PLUS survey. (N = 14,000) PRINCIPAL FINDINGS: The integration of child-level PHDS-PLUS, program participation, utilization and other data enabled more efficient, comprehensive and actionable measurement of EPSDT services, including the often unassessed areas of anticipatory guidance and parental education, services for children at-risk for developmental problems and family psychosocial assessment. EPSDT measure performance varied according to a wide-range of policy relevant variables such as program participation, care setting and type and continuity of provider, priority population subgroups (e.g. racial/ethnic groups, CSHCN), organization of care and geographic area. States varied in quality and performance for 10 of the 11 measures. Quality measures on well-child visits were not predictive of performance on the aspects of EPSDT services assessed by the PHDS-PLUS within or across states. Data collected enabled the broad application of findings and engagement of multiple state partners to begin to improve care. CONCLUSIONS: Medicaid programs can enhance the value and maximize the use of quality measurement resources if a comprehensive set of consumer-centered and program data is collected and integrated at the child-level through a collaborative process within their state. Doing so allows for more robust and actionable evaluations that can inform efforts to improve care across a range of EPSDT services, including areas often not measured such as anticipatory guidance, developmental screening and follow up and family psychosocial assessment. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The pivotal role of Medicaid in ensuring the high-quality provision of EPSDT services is enhanced through the use of a collaborative, integrated, consumer-centered model such as that implemented through the Promoting Healthy Development State Learning Network described here.

Publication Types:

• Meeting Abstracts

Keywords:

• Case-Control Studies
• Child
• Data Collection
• Delivery of Health Care
• Financial Management
• Health Care Surveys
• Health Services
• Health Services Research
• Humans
• Medicaid
• Parents
• Research Design
• economics
• organization & administration
• hsrmtgs

UI: 103623831

From Meeting Abstracts