Date of Award

Spring 2000

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program/Concentration

Urban Services--Health Services

Committee Director

Brenda Nichols

Committee Member

Clare Houseman

Committee Member

Lindsay Rettie

Committee Member

Stacey Plichta

Abstract

The Behavior Model of Utilization played a key role in explaining health services use for pediatric members with asthma in one urban, regional managed care company. The critical role the asthma management program played in promoting the health and well-being of enrolled members was elucidated. Information gleaned from this empirical study can be used to encourage appropriate resource utilization, formulate pediatric asthma health policy, and deliver cost-effective, quality health care. More importantly, managed care company administrators and clinicians can demonstrate the value of their efforts by achieving measurable improvements in the health and well-being of children in the communities they serve.

To improve the health and well-being of children with asthma, health policy makers and clinicians must understand both the context within which asthma health services occur and the relative contribution of patient-related factors and contextual factors to health services use. Therefore, this research used the Behavior Model of Utilization to explore the relative contribution of patient-related factors and contextual factors to pediatric asthma health services utilization behaviors. The conceptual framework offered a systematic and organized approach to identify and test various factors that influence pediatric asthma health services. More importantly, the conceptual model ensured all available factors were equally considered.

A non-experimental, observational, longitudinal historical research design with three independent groups was used to test the explanatory power of the Behavior Model of Utilization. This study was unique in that one of the comparison groups included participants who declined to enroll in the asthma management program despite referral by their primary care providers. Data sets were linked to create an individual sample of children with their primary care providers. Explanatory models, based on logistic regression analyses, were developed at the participant and primary care provider level. Previously unexplored variables, such as primary care provider gender and the availability of neighborhood-based primary care provider services, were included in the model. In this study, the child was the unit of analysis instead of the health services resource claim.

Study results revealed that the asthma management program, a contextual factor, significantly reduced the likelihood of using health services and controlled cost for this insured pediatric population. Participants enrolled in the asthma management program were significantly less likely to be admitted to the hospital, use emergency department services, or use specialist services. Participants were also significantly less likely to be classified high total health care cost. These results were further supported when pre-test year results were compared to post-test year results. Finally, these participants were significantly less likely to use beta-agonist medications than participants not enrolled in the program.

Study results also revealed that the asthma management program was the only significant predictor variable across all health services outcome measures, when holding the pre-test year measures constant The asthma management program contributed more to the explanatory power of the Behavior Model of Utilization than population-related factors or environment-related factors. Additionally, the program contributed as much or more to, the explanatory power of the model than pre-test year measures. Finally, the asthma management program enabled the managed care company to meet health policy objectives and positions the company to receive a favorable review for the asthma quality indicator defined by the National Committee for Quality Assurance.

DOI

10.25777/d67e-5q54

ISBN

9780599754751

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