Quality of Primary Care for Children With Disabilities Enrolled in Medicaid

Acad Pediatr. May-Jun 2017;17(4):443-449. doi: 10.1016/j.acap.2016.10.015. Epub 2017 Mar 9.

Abstract

Objective: The quality of primary care delivered to Medicaid-insured children with disabilities (CWD) is unknown. We used the newly validated CWD algorithm (CWDA) to examine CWD prevalence among Medicaid enrollees 1 to 18 years old, primary care quality for CWD, and differences in primary care quality for CWD and non-CWD.

Methods: Cross-sectional study using 2008 Medicaid Analytic eXtract claims data from 9 states, including children with at least 11 months of enrollment (N = 2,671,922 enrollees). We utilized CWDA to identify CWD and applied 12 validated or endorsed pediatric quality measures to assess preventive/screening, acute, and chronic disease care quality. We compared quality for CWD and non-CWD unmatched and matched on age, sex, and number of nondisabling chronic conditions and outpatient encounters.

Results: CWDA identified 5.3% (n = 141,384) of our study population as CWD. Care quality levels for CWD were below 50% on 8 of 12 quality measures (eg, adolescent well visits [44.9%], alcohol/drug treatment engagement [24.9%]). CWD care quality was significantly better than the general population of non-CWD by +0.9% to +15.6% on 9 measures, but significantly worse for 2 measures, chlamydia screening (-3.4%) and no emergency department visits for asthma (-5.0%; all P < .01 to .001). Differences in care quality between CWD and non-CWD were generally smaller or changed direction when CWD were compared to a general population or matched group of non-CWD.

Conclusions: One in 20 Medicaid-insured children is CWD, and the quality of primary care delivered to CWD is suboptimal. Areas needing improvement include preventive/screening, acute care, and chronic disease management.

Keywords: Medicaid; children; disabilities; pediatrics; quality of care.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Arizona
  • Child
  • Child Health Services / standards*
  • Child, Preschool
  • Cross-Sectional Studies
  • Disabled Children*
  • Female
  • Humans
  • Indiana
  • Infant
  • Kansas
  • Kentucky
  • Male
  • Medicaid
  • Missouri
  • New Jersey
  • New Mexico
  • Pediatrics / standards*
  • Primary Health Care / standards*
  • Quality Assurance, Health Care
  • Quality of Health Care*
  • United States
  • Virginia
  • Wisconsin