The 130th Annual Meeting of APHA

Abstract #44095

Jacqueline J. Fickel, LBJ School of Public Affairs, University of Texas at Austin, P.O. Box Y, University Station, Austin, TX 78713-8925, 512-243-1587, jjfickel@mail.utexas.edu

This research describes use of information from various quality of care assessment methods by state Medicaid administrators, identifying associations between use of information and factors that may influence use. Telephone interviews were completed with a nation-wide cross-section of 82 state Medicaid administrators from 48 State Medicaid Agencies, on: (1) activities for which they use information from 8 targeted quality of care measures, plus (2) their attitudes regarding the usefulness of that information, their level of understanding of the measurement methods, and other characteristics of their jobs and the policy environments in which they work. Associations between use of information from each of the measures and the knowledge, perception, and environment variables were evaluated with point biserial correlations and chi-square tests. In addition, descriptions were elicited of actions or situations that had been especially helpful or problematic in their agencies' quality of care assessment efforts. A large majority of subjects reported positive attitudes in general about assessing quality of care, familiarity with a wide variety of assessment methods, and using information about quality of care in several different administrative activities. However, most reported using information from only a few measures, primarily enrollee satisfaction surveys and encounter data. The two factors most strongly associated with use of information from a particular measure were (1) ratings of the overall usefulness of the measure for quality assessment, and (2) the purposes for which subjects used the information. In addition, subjects described several common problems they have experienced in trying to use specific measures. Some problems were inherent to attempting to use certain methods to measure quality of care, though many were related to implementation difficulties, such as inadequate technical expertise. Subjects who described actions that had been helpful in overcoming those problems frequently mentioned the benefits of using several different types of measures in conjunction, in order to get a more complete picture. The findings suggest that the primary barrier for state Medicaid administrators' use of information about quality of care is inadequacy of information that is appropriate to their needs. Also, relying upon any one measure provides an incomplete picture of the quality of care available in the program. These results have implications for the selection of quality of care assessment measures that will meet administrators' information needs, especially a set of complementary measures from which to integrate information for a fuller picture of quality of care available to people in Medicaid.

Learning Objectives:

• Identify the quality of care measures from which information is most often used by state Medicaid programs.
• Describe strengths and problems noted with 8 targeted quality of care measures.
• Describe actions and factors which are helpful in, or barriers to, quality of care assessment in Medicaid managed care programs.

Keywords: Quality of Care, Quality Improvement

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.