Assessing the quality of asthma care provided to Medicaid patients enrolled in managed care organizations in Connecticut

Background: Many states have enrolled Medicaid beneficiaries in managed car e organizations (MCOs). Few assessments of the quality of asthma care provi ded by these new programs are available. Objective: To describe the quality of care provided to asthmatic Medicaid c hildren enrolled in MCOs. Methods: For this cross-sectional survey, a chart abstraction tool was deve loped to evaluate fulfillment of key performance measures chosen from a nat ional guideline for asthma diagnosis and management. These measures were pr escription of an inhaled anti-inflammatory medication, accomplishment of pa tient education, evaluation of exposure to environmental triggers of asthma , and administration of influenza vaccination. From State of Connecticut ad ministrative databases, a random sampling of Medicaid children, ages 5 to 1 8 years, enrolled in four MCOs was selected. Chart entries from July 1, 199 6 to June 30, 1997 were reviewed using the abstraction tool. Accomplishment of performance measures was evaluated for the total sample and for childre n who were high utilizers of medical services (at least one ED visit or hos pitalization during the study period). Results: For 80 high utilizers among 315 children, completion of performanc e measures was suboptimal: 46% were prescribed inhaled steroids; an action plan was outlined for 43%; evaluation of patient or family tobacco use was documented for 56%; evaluation of the presence of a pet for 43% or mite exp osure for 19%; and allergy skin testing or RAST was accomplished for 15%. Conclusions: This information suggests that opportunities exist to improve the quality of care for these children.