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Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.Person-level claims and encounter data for 2006-2010 were used to compute adherence to 6 quality measures. With county as the independent sampling unit, we employed a longitudinal linear mixed-model analysis accounting for administrative clustering and geographic and individual factors.Although quality was similar among programs at baseline, STAR+PLUS enrollees experienced large and sustained improvements in use of β-blockers after discharge for heart attack (49% vs. 81% adherence posttransition; P0.01) and appropriate use of systemic corticosteroids and bronchodilators after a chronic obstructive pulmonary disease event (39% vs. 68% adherence posttransition; P0.0001) compared with FFS/PCCM enrollees. No statistically significant effects were identified for quality measures for asthma, diabetes, or cardiovascular disease.In 1 large Medicaid-managed care HCBS program, the quality of chronic disease care linked to acute events improved while that provided during routine encounters appeared unaffected.

E of racial and ethnic health disparities associated with socioeconomic differences is remarkably consistent across chronic illnesses and health care services. In 1985, the U.S. Dept. of Health and Human Services released the Secretary’s Task Force on Black and Minority Health.1 This report was one of the first federal documents to highlight disparities in health and health care between the majority and racial and ethnic minority populations. Subsequent research demonstrates an increased burden of disease for our vulnerable homeless, impoverished rural, migrant, and public housing communities, which suffer greater morbidity and mortality than the general population.2 Health care reform efforts targeted toward these diverse underserved populations must capitalize on advances in health information technology (IT) and best practices. Health IT is a vital tool in achieving the goals of health care reform to increase health care access, improve care delivery systems, engage in culturally competent outreach and education, and enhance workforce development and training. The first national survey of federally funded community health centers shows that although 26% reported some electronic health record (EHR) capacity and 13% have the minimal set of EHR functionalities, the centers serving the most poor and uninsured patients were less likely to have a functional HER system.3 Community health centers, free clinics and other safety net organizations aim to deliver evidence-based, patient-centered, culturally competent, efficient, high quality health care to underserved populations. Electronic health records can help the health delivery system achieve those goals.

The objectives of this project were to (a) assess hypertension and diabetes screening data collection practices and guidelines and (b) develop and test standardized screening forms for use at minority community- and faith-based screening events. Project Phase I involved resource assessment and the development of a set of screening forms and guidelines containing a core data set for both hypertension and diabetes. These were then tested during Phase II at predetermined communitybased screening events throughout the United States. Community- and faith-based health screening programs are important in reaching and informing individuals in selected communities about their health and health risks. This study demonstrated the development of a standard tool that was effective in conducting African American community-based screening programs for hypertension and diabetes by community-based organizations. These activities are effective to obtain standardized information on individuals within the communities served.