The objective of this study was to determine the prevalence and predictors of testing for sexually transmitted infections (STIs) under an accountable care model of health care delivery. Data sources were claims and encounter records from the Massachusetts Medicaid and Children's Health Insurance Program (MassHealth) for enrollees aged 13 to 64 years in 2019. This cross-sectional study examines the one-year prevalence of STI testing and evaluates social determinants of health and other patient characteristics as predictors of such testing in both primary care and other settings. We identified visits with STI testing using procedure codes and primary care settings from provider code types. Among 740,417 members, 55% were female, 11% were homeless or unstably housed, and 15% had some level of disability. While the prevalence of testing in any setting was 20% (N = 151,428), only 57,215 members had testing performed in a primary care setting, resulting in an 8% prevalence of testing by primary care clinicians (PCCs). Members enrolled in a managed care organization (MCO) were significantly less likely to be tested by a primary care provider than those enrolled in accountable care organization (ACO) plans that have specific incentives for primary care practices to coordinate care. Enrollees in a Primary Care ACO had the highest rates of STI testing, both overall and by primary care providers. Massachusetts' ACO delivery systems may be able to help practices increase STI screening with explicit incentives for STI testing in primary care settings.

中文翻译：

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初级保健提供者在 MassHealth 医疗补助计划中性传播感染检测中的作用。

本研究的目的是确定在医疗保健提供的责任护理模式下性传播感染 (STI) 检测的患病率和预测因素。数据来源是马萨诸塞州医疗补助和儿童健康保险计划 (MassHealth) 2019 年针对 13 至 64 岁参保者的索赔和遭遇记录。这项横断面研究考察了性传播感染检测的一年流行率，并评估了健康和儿童健康的社会决定因素。其他患者特征作为初级保健和其他环境中此类测试的预测因素。我们使用提供商代码类型中的程序代码和初级保健设置来识别性传播感染测试的访问。在 740,417 名成员中，55% 是女性，11% 无家可归或住房不稳定，15% 有一定程度的残疾。虽然任何环境下的检测流行率为 20% (N = 151,428)，但只有 57,215 名会员在初级保健环境中进行了检测，导致初级保健临床医生 (PCC) 的检测流行率为 8%。与加入责任医疗组织 (ACO) 计划的会员相比，加入管理式医疗组织 (MCO) 的会员接受初级保健提供者测试的可能性要小得多，而责任医疗组织 (ACO) 计划对初级保健实践有特定的激励措施来协调护理。初级保健 ACO 的参与者的性传播感染检测率最高，无论是整体检测还是初级保健提供者的检测。马萨诸塞州的 ACO 交付系统可能能够帮助实践增加性传播感染筛查，并明确激励初级保健机构中的性传播感染检测。