Medicaid medical directors quality improvement studies: a case study of evolving methods for a research network

To describe the evolution of methods and share lessons learned from conducting multi-state studies with Medicaid Medical Directors (MMD) using state administrative data. There was a great need for these studies, but also much to be learned about conducting network-based research and ensuring comparability of results.

This was a network-level case study. The findings were drawn from the experience developing and executing network analyses with the MMDs, as well as from participant feedback on lessons learned. For the latter, nine interviews with MMD project leads, state data analysts, and outside researchers involved with the projects were conducted. Interviews were transcribed, coded and analyzed using NVivo 10.0 analytic software.

MMD study methodology involved many steps: developing research questions, defining data specifications, organizing an aggregated data collection spreadsheet form, assuring quality through review, and analyzing and reporting state data at the national level. State analysts extracted the data from their state Medicaid administrative (claims) databases (and sometimes other datasets). Analysis at the national level aggregated state data overall, by demographics and other sub groups, and displayed descriptive statistics and cross-tabs.

Projects in the MMD multi-state network address high-priority clinical issues in Medicaid and impact quality of care through sharing of data and policies among states. Further, these studies contribute not only to high-quality, cost-effective health care for Medicaid beneficiaries, but also add to our knowledge of network-based research. Continuation of these studies requires funding for a permanent research infrastructure nationally, as well as at the state-level to strengthen capacity.