Article

OBJECTIVES: To develop activity limitation clusters for case-mix adjustment of
health care ratings and as a population profiler, and to develop a cognitively
accessible report of statistically reliable quality and access measures comparing
the health care experiences of adults with and without disabilities, within and
across health delivery organizations. DESIGN: Observational study. SETTING: Three
California Medicaid health care organizations. PARTICIPANTS: Adults (N = 1086) of
working age enrolled for at least 1 year in Medicaid because of disability.
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Principal components
analysis created 4 clusters of activity limitations that we used to characterize
case mix. We identified and calculated 28 quality measures using responses from a
proposed enabled version of the Consumer Assessment of Healthcare Providers and
Systems (CAHPS) survey. We calculated scores for overall care as the weighted
mean of the case-mix adjusted ratings. RESULTS: Disability caused a greater bias
on health plan ratings and specialist ratings than did demographic factors. Proxy
respondents rated care the same as self-respondents. Telephone and mail
administration were equivalent for service reports, but telephone respondents
tended to offer more positive global ratings. Plan-level reliability estimates
for new composites on shared decision making and advice on healthy living are .79
and .87, respectively. Plan-level reliability estimates for a new composite
measure on family planning did not discriminate between health plans because
respondents rated all health plans poorly. Approximately 125 respondents per site
are necessary to detect group differences. CONCLUSIONS: Self-reported activity
limitations incorporating standard questions from the American Community Survey
can be used to create a disability case-mix index and to construct profiles of a
population's activity limitations. The enabled comparative report, which we call
the Assessment of Health Plans and Providers by People with Activity Limitations,
is more cognitively accessible than typical CAHPS report templates for state
Medicaid plans. The CAHPS Medicaid reporting tools may provide misleading ratings
of health plan and physician quality by people with disabilities because the mean
ratings do not account for systematic biases associated with disability. More
testing on larger populations would help to quantify the strength of various
reporting biases.

Langue : ANGLAIS