Table 2.
Practice Site Reports of Asthma Processes of Care Sorted by Rating within Each Type of Process
| Processes of Asthma Care | Percent Usually/Always | Mean | SD | Rank | Intraclass Correlation Coefficient within MCO |
|---|---|---|---|---|---|
| Self-Management Support | |||||
| Teach spacer technique | 88 | 3.42 | 1.12 | 1 | .04 |
| Peak flow meters available, low cost | 83 | 3.29 | 1.99 | 2 | .18 |
| Spacers available, low cost | 83 | 3.26 | 0.99 | 3* | .16 |
| Nebulizers available, low cost | 74 | 2.99 | 1.14 | 12 | .16 |
| Make written care plan accessible to primary care, urgent care | 54 | 2.46 | 1.13 | 16 | <.01 |
| Prepare individualized written care plans | 44 | 2.42 | 0.90 | 17 | −.02 |
| Provide self-management support by referral to designated asthma nurse or educator | 50 | 2.40 | 1.04 | 18 | .08 |
| Promote self-management support using problem- solving, empowerment methodologies | 49 | 2.26 | 0.97 | 20 | .01 |
| Assess self-management needs | 10 | 1.49 | 0.82 | 25 | −.03 |
| Mean ICC for all self- management support items | .08 | ||||
| Delivery System Design | |||||
| Ensure primary care provider assignment | 86 | 3.18 | 0.99 | 8 | −.02 |
| Systematically promote continuity in appointments | 92 | 3.19 | 0.78 | 7 | .05 |
| Primary care provider for same-day appointments | 88 | 3.20 | 0.76 | 6 | .10 |
| Ensure primary care follow- up after urgent care visit | 90 | 3.22 | 0.61 | 5 | .26* |
| Promote preventive asthma management visits | 75 | 3.04 | 0.81 | 11 | .16 |
| Use asthma nurses, other case managers | 42 | 2.32 | 1.14 | 19 | .37* |
| Mean ICC for all delivery system design items | .16 | ||||
| Information Systems | |||||
| Reminders about guidelines at individual encounters | 33 | 2.03 | 1.07 | 21 | .09 |
| Feedback reports to providers to improve asthma care | 30 | 1.94 | 0.96 | 22 | .24* |
| Provide registries to clinicians | 14 | 1.66 | 0.88 | 23* | .54* |
| Use registries to prompt clinicians regarding guidelines | 21 | 1.66 | 1.06 | 23* | .34* |
| Mean ICC for all information systems items | .30 | ||||
| Decision Support | |||||
| Promote two-way communication between specialist and primary care | 88 | 3.26 | 1.17 | 3* | −.05 |
| Facilitate specialist referral for difficult cases | 84 | 3.07 | 1.02 | 10 | −.01 |
| Promote guidelines | 83 | 3.12 | 0.97 | 9 | .07 |
| Involve specialists involved in primary care for asthma | 53 | 2.55 | 0.90 | 15 | .01 |
| Asthma education for primary care providers, nurses | 51 | 2.59 | 0.94 | 14 | .09 |
| Mean ICC for all decision support items | .03 | ||||
| Community Linkages | |||||
| Coordinate with community resources, e.g. school nurse | 56 | 2.60 | 0.74 | 13 | .05 |
| Mean ICC for community linkages item | .05 | ||||
| Health System | |||||
| Contractual incentives | 1 | 1.04 | 0.48 | 26 | −.03 |
| Mean ICC for health system item | −.03 | ||||
Mean score: 1=never, 2=occasionally, 3=usually, 4=always. Rank is based on mean score.
ICC=intraclass correlation coefficient=Var(MCO)/[Var(PS)+Var (MCO)]. ICCs were not truncated at zero.
The strength of correlation between each individual process of care and MCO was defined as weak: (ICC<.1 or p>.05), moderate (p<.05 and ICC between .1 and .299) or strong (p<.05 and ICC .300 or greater). Asterisk denotes moderate or strong correlation, and, by definition, p<.05. Mean ICC for each domain represents the mean of the ICCs for each item in the domain. Strength of correlation was not rated for mean ICCs.