Continuity and quality of care for children with diabetes who are covered by medicaid

Ambul Pediatr. Mar-Apr 2001;1(2):99-103. doi: 10.1367/1539-4409(2001)001<0099:caqocf>2.0.co;2.

Abstract

Background: Poor and minority children with Type 1 diabetes mellitus are at increased risk of severe adverse outcomes as a result of their disease. However, little is known about the quality of care that these children receive and which factors are associated with better quality of care.

Objectives: Our objectives were as follows: 1) to describe the utilization of services associated with quality of care for children with Type 1 diabetes mellitus who are covered by Medicaid and 2) to test the hypothesis that increased continuity of primary care is associated with better care for these children.

Design: Retrospective cohort study.

Methods: Washington State Medicaid claims data for 1997 were used to determine what proportion of children with diabetes had 1) an inpatient or outpatient diagnosis of diabetic ketoacidosis (DKA), 2) a glycosylated hemoglobin (HgA1c) level that had been checked, 3) a retinal examination, and 4) thyroid function studies. Continuity of care was quantified using a pre-established index.

Results: Two hundred fifty-two eligible patients were identified. During the observation year, 20% had an outpatient diagnosis of DKA, 6% were admitted with DKA, 43% visited an ophthalmologist, 54% had their HgA1c checked, and 21% had their thyroid function assessed. Children with high continuity of care were less likely to have DKA as an outpatient (0.30 [0.13-0.71]). Children with medium continuity of care and high continuity of care were less likely to be hospitalized for DKA (0.22 [0.05-0.87] and 0.14 [0.03-0.67], respectively). For preventive services utilization, high continuity of care was associated only with an increased likelihood of visiting an ophthalmologist (2.80 [1.08-3.88]).

Conclusions: The quality of care for Medicaid children with diabetes can be substantially improved. Low continuity of primary care is an identifiable risk factor for DKA.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child Health Services / economics
  • Child Health Services / standards*
  • Child, Preschool
  • Cohort Studies
  • Continuity of Patient Care / economics
  • Continuity of Patient Care / standards*
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / economics*
  • Diabetes Mellitus, Type 1 / therapy*
  • Disease Management
  • Female
  • Humans
  • Logistic Models
  • Male
  • Medicaid / standards*
  • Odds Ratio
  • Pediatrics / economics
  • Pediatrics / standards*
  • Probability
  • Quality Assurance, Health Care*
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Washington