Study highlights link between cultural competence and quality of care in asthma

Literature Update 4, October 2004

A recent study published in the journal Pediatrics explored various policies and features of practice-sites to determine which ones were associated with quality of care for Medicaid-insured children with asthma (7). This prospective cohort study was conducted across 5 health plans in California, Washington, and Massachusetts. Data were collected at baseline and after one year via telephone interviews with parents, surveys of practice sites and clinicians, and computerized databases. The practice site survey asked about policies to promote cultural competence (including cultural competence training), the use of several types of reports to clinicians, support for self-management of asthma, case management and care coordination, and access to and continuity of care.

In multivariate analyses of the 1163 children in the study population, patients at practice sites with the highest cultural competence scores did significantly better on two of the five quality of care measures. They were less likely to under use preventive asthma medications based on parent report, and they had better parent ratings of care. The study also found that the use of reports to clinicians, and access and continuity predicted higher quality of care for children with asthma in managed Medicaid. The authors conclude that efforts to improve care for this vulnerable group should focus on practice-site policies including cultural competence.