Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

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areas of MCOs and contains information on health plan type, profit status, membership size, andmodel type. Organizational characteristics of the universe of MCOs are provided in Exhibit 1.Exhibit 1ORGANIZATIONAL STRUCTURE OF MCOS IN THEAAHP 2001 DIRECTORY OF HEALTH PLANSUnavailable2% (n=16)Health Plan TypeHMO29% (n = 263)Mix45% (n=403)PPO23% (n = 210)POS1% (n=12)IPA31% (n = 280)Model TypeNetwork15%(n = 133)Unavailable18% (n=14)Group8% (n=6)Group4% (n=36)Staff2% (n=12)Mix7% (n=68)Profit StatusNon -profitFor Profit32% (n =293)68% (n =611)Membership Size*Small Large32% (n = 290) 25% (n = 232)Medium38% (n=340)Unavailable5% (n=42)* • Smalall = 500-49,999• Medium = 50,000000 -199,999• Lararge = 200,000+Disadvantages associated with using an association’s directory as a study sampling frameare shared by any similar directory. First, directory listings typically have a lag of about a yearbetween information collection and publication, which could be especially problematic for thisstudy considering the level of consolidation occurring in the health care system at that time.Second, because directories often serve as a sort of yellow pages where purchasers can seek outorganizations in certain geographic locales, listings are often too detailed and repetitious. Suchrepetition may require a fair amount of file manipulation to remove duplicate listings, at somecost.During the study design phase, several characteristics and conditions were explored andconsidered for developing an appropriate sampling strategy. The most important component wasto ensure that the study sample would reflect a nationally representative group of MCOs. Asecond consideration was that the MCOs selected for study participation should includeorganizational, membership, and geographic variation.Discussions were held among the research team, OMH staff, and the project advisorygroups to determine the appropriate strategy. Initially, the research team proposed severalvariables for stratifying the sample of MCOs, including the metropolitan statistical areas (MSAs)in which the organizations reside; organizational characteristics such as health plan type,profit/non-profit status, or membership size of each MCO; and demographic characteristics (e.g.,racial, ethnic, cultural, and linguistic composition) of the population served by each MCO.Following extensive deliberations, members of the expert panel advised that the rapidlychanginglandscape of health plans—at both the service and organizational levels—was tooCOSMOS Corporation, December 2003 G-3
complex and uncertain at the time to employ a stratified sampling strategy of any sort. Becausethe health care system was in a fluid and evolutionary state, many MCOs were merging withother organizations, and many were going out of business. As such, characteristics or conditionsthat would normally be used to stratify a sample of MCOs were transient during the time of thisstudy. Therefore, the group concluded that the most appropriate strategy for selecting the studysample was the most parsimonious one, i.e., a national random selection of MCOs.To ensure that the sample drawn would be representative of all MCOs, calculations wereperformed to determine the degree of precision with which generalizations could be made to thetarget national population. The most typical measure of survey precision is the widths ofconfidence intervals for simple univariate estimates and for estimates within analyticalsubgroups. An analysis of confidence intervals for this study revealed that a sample of 240MCOs (from the universe of approximately 1,100 at the time) would allow 95 percentconfidence intervals for categorical variables that have widths of approximately 4-7 percent. Fortypical subgroup analyses utilizing six subgroups, a sample of 240 MCOs would yieldconfidence intervals that range in width from 6-15 percent, depending on the size of thesubgroup sample and the particular variable.2. DEVELOPING THE DATA COLLECTION PLANOnce the three respondent types (per MCO) were identified, the next step was to develop adata collection plan which would most likely render a high response rate. Here too, however, therapidly-changing structure of MCOs at the time—i.e., the evolution of the organizationsthemselves, as well as changes in the staff within the organizations—influenced the decisionsmade during the data collection planning phase.The first point of contact with each MCO would be an introductory letter mailed to theorganization’s senior executive, as listed in the AAHP directory, with a follow-up telephone callconducted to confirm receipt of the letter and determine the senior executive’s availability forstudy participation. The contact information in the directory provided a starting point forpenetrating the MCOs and for determining the appropriate senior executive to complete thetelephone interview.An interview is the most appropriate method for gathering information on an organization’spolicies, histories, and future plans; because the types of information to be collected typicallyrequire the participation of senior-level executives who have busy schedules, these respondentsare more likely to agree to a telephone interview than to a face-to-face interview (Marshall andRossman 2000). The telephone interviews for this study would be conducted using ComputerAssisted Telephone Interviewing (CATI) by experienced interviewers who would receivetraining specifically for this data collection effort. The use of CATI provides a number of timesavingadvantages in the data collection process including: electronic recording of aparticipant’s responses (eliminating the manual data entry step); electronic guidance through theinterview (e.g., making appropriate skips automatically based on the respondent’s answers); andlogic checking capability to ensure consistent responses.COSMOS Corporation, December 2003 G-4
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Developing a Self-Assessment Toolfo
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ContentsChaptersPage1. Introduction
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Chapter 1Introduction
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While many LPHAs currently provide
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LPHAs include: adult and child immu
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Professions Education Partnership A
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Chapter 2Methodology for Developing
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Public Health Practice Program Offi
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assess their own beliefs and have k
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communicate with, and clearly under
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2.1.6 Identifying Key Components of
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Given these persistent disparities
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(Exhibit 2-2, Continued)DOMAIN / KE
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limited to the actual clinical enco
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Chapter 3Project Results and Recomm
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local board of health. PEP and PAG
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numerous promising CLAS practices a
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References
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Becker, M.H., and L.A. Maiman, “S
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Frye, B., “Health Care Decision M
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Marin, G., “Defining Culturally A
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Perkins, Jane, “Overcoming Langua
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U.S. Bureau of the Census, “Censu
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Appendix AMembership Lists of the P
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Appendix A-1Developing a Self-Asses
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Appendix A-2Developing a Self-Asses
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Appendix B-1Overview of Eight CLAS
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Domain 3: Culturally Inclusive Heal
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understanding of diversity issues i
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Appendix B-2Conceptual Framework fo
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Appendix CLPHA Director or Designee
Page 63 and 64: Pre-Interview Script for LPHA Direc
Page 65 and 66: 3b. Which of the following are refl
Page 67 and 68: 6. Does your agency have a formal p
Page 69 and 70: 10. Which of the following describe
Page 71 and 72: Post-Interview Script for LPHA Dire
Page 73 and 74: Appendix DStaffing Questionnaire
Page 75 and 76: A. QUALITY MONITORING AND IMPROVEME
Page 77 and 78: B. MANAGEMENT INFORMATION SYSTEMS (
Page 79 and 80: 7. Please indicate, if you know, th
Page 81 and 82: 1c. Please indicate for which categ
Page 83 and 84: 6. Please indicate for which catego
Page 85 and 86: 10. Which of the following topical
Page 87 and 88: 17. Which of the following benefits
Page 89 and 90: 4. Which of the following strategie
Page 91 and 92: Appendix EClient Services Questionn
Page 93 and 94: A. QUALITY MONITORING AND IMPROVEME
Page 95 and 96: 6b.Which of the following community
Page 97 and 98: 3. Please report or estimate what p
Page 99 and 100: 3. Which of the following practices
Page 101 and 102: Oral Interpretation Services10. Whi
Page 103 and 104: 16. At which of the following key e
Page 105 and 106: 3. Which of the following kinds of
Page 107 and 108: Appendix FPilot Test Response Form
Page 109 and 110: RESPONDENT EVALUATIONOF THE QUESTIO
Page 111 and 112: Appendix GCLAS in MCOs Study Data C
Page 113: position, as titles will likely var
Page 117 and 118: 1. Incorporate a confirmation pre-c
Page 119 and 120: Exhibit 2DATA COLLECTION PROCESSSen
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