Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users.

PURPOSE: To evaluate whether quality of care provided to adolescents enrolled in a community-based managed care plan was better for those who also received some care at school-based health centers (SBHCs). METHODS: The Young Adult Health Care Survey (YAHCS) was administered to 374 adolescents (commercially insured, Medicaid-insured, and SBHC users) to assess risk behaviors, provision of preventive screening and counseling, and quality of care. RESULTS: SBHC users were most likely to report that their provider told them their discussions were confidential, and that they received screening/counseling on sexually transmitted diseases (STDs), HIV/AIDS, condom use, and birth control. Commercially insured adolescents were least likely to report discussion of sexual health issues. SBHC users had the highest mean YAHCS quality measure scores for screening/counseling on pregnancy/STDs, diet and exercise, and helpfulness of counseling provided; Medicaid-insured teens had the lowest scores on four of seven measures. Regression models controlled for demographics, use of screener, and site of care showed that use of a screener had a significant impact on six of seven quality measure models. Younger age predicted screening for risk behaviors; being female, African-American, and an SBHC user predicted screening on pregnancy/STDs. CONCLUSIONS: SBHCs may increase adolescents' access to confidential care, and SBHC providers may be more likely than those in other settings to screen and counsel patients about sexual health. Overall quality of preventive care reported by commercially insured adolescents may be better in some health content areas and worse in others compared with care reported by Medicaid-insured youth and SBHC users.

Improving adolescent preventive services through state, managed care, and community partnerships.

PURPOSE: To develop and evaluate a multipronged, guideline-based initiative to improve quality of adolescent preventive care. METHODS: Activities included: (a) academic institution-based grand rounds and insurance company-sponsored community rounds continuing education sessions on preventive care for primary care clinicians, (b) academic detailing during chart review visits to practices by nurse reviewers, to encourage adolescent-specific confidentiality policies and use of screener or trigger questionnaires during well visits, and (c) partnerships with community corporate leaders to promote awareness of quality preventive services. Interventions were evaluated by comparing 2000 and 2001 chart reviews for rates of tobacco use, substance use, and human immunodeficiency virus (HIV) prevention screening and counseling. RESULTS: A total of 285 clinicians attended continuing education (CE) sessions and 96 offices received detailing visits. Improvements in adolescent preventive health services delivery were noted in both commercial and Medicaid populations. We found the following when comparing 2001 results with those from 2000: Tobacco use screening or counseling increased from 42.5% to 45.5% for the commercial population and from 32.0% to 43.5% for the Medicaid population; substance use screening increased from 42.5% to 44.0% for the commercial population and from 32.0% to 43.5% for the Medicaid population. HIV counseling increased from 26.5% to 35.5% for the commercial population, and from 28.0% to 40.0% for the Medicaid population (all Medicaid and HIV differences are significant at p <.05). CONCLUSIONS: These activities have been successful in improving adolescent preventive services for Medicaid populations in New York. Academic detailing can assist health plans in promoting preventive care improvements by primary care clinicians. Further measurement is needed to assess the effect on commercially insured populations.