322 Background: The Affordable Care Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid beneficiaries aimed at standardizing health care quality measurement across state Medicaid programs. On January 1, 2013, the Medicaid Quality Measurement Program was established to fund the development, testing, and validation of the adult health quality measures. The Medicaid Adult Core Set of Adult Health Care Quality includes two cancer screening measures (Exhibit 1). With grants from The Centers for Medicare & Medicaid Services (CMS), three state Medicaid agencies carried out quality improvement projects (QIPs) aimed at increasing breast and cervical cancer screening rates. This study describes a qualitative assessment of these states’ QIPs. Methods: Data included grantee applications, semi-annual, and annual progress reports to CMS, as well as in-depth interviews with grantees. Qualitative content analysis (using both structured abstraction and deductive and inductive coding) was conducted in NVivo 11. Results: Breast and cervical cancer screening rates for adult Medicaid beneficiaries improved in these states during the 3-year grant. The most effective interventions identified by the states included: System-level interventions such as the distribution of performance dashboards with peer comparison data; Provider-level interventions such as the distribution of unmet need or gap-in-care reports; and Beneficiary-level interventions such as direct nurse outreach to beneficiaries with a gap in care. Conclusions: QIPs can improve breast and cervical cancer screening rates in adult Medicare beneficiaries. The most effective interventions are multi-pronged and should target health care systems, providers, and beneficiaries.[Table: see text]
Effect of Health Care System Distrust on Breast and Cervical Cancer Screening in Philadelphia, Pennsylvania
