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[ Recorded presentation ] Recorded presentation

System and Provider Characteristics in Blood Glucose Monitoring among Black and White Adults Medicaid Beneficiaries with Diabetes Mellitus

Robert M. Mayberry, MPH, PhD1, Aziz Samadi, MD, MPH1, Ernest Alema-Mensah, MS, DMin1, and Rita Finley, PhD2. (1) Program for Healthcare Effectiveness Research, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA 30310, 404-752-1878, Mayberr@msm.edu, (2) Assistant Professor of Biology, Morehouse College, 720 Westview Drive, SW, Atlanta, GA 30310

Objective: The objective of this study was to evaluate the frequency of blood glucose monitoring among Black and White beneficiaries with diabetes enrolled in Georgia Medicaid mandatory primary care case management program, Georgia Better Health Care (GBHC), relative to the care of beneficiaries enrolled in the traditional fee-for-service (FFS) health plan option. Study Design: This retrospective cohort study used Georgia Medicaid eligibility and provider claim data for the period 1996-1998 to assess the quality of diabetes care. Black and White Medicaid beneficiaries with newly diagnosed diabetes in 1996 and 1997 were followed for a 12-month period (since diabetes diagnosis) through year 1997 and year 1998, respectively, according to claim histories. The frequency of HbA1c testing was assessed according to race and health plan options. Diabetes diagnoses were based on physician-reported new claims of type 2 diabetes (ICD-9-CM codes 250.0 -250.9). The HbA1c tests was identified in Medicaid claim files according to CPT codes. Multivariate logistic regression modeling was used to examine the relationships between race, health care plan, and physician characteristics and the rate of blood gucose testing while adjusting for covariates in the model. Results: The results of this investigation indicated poor blood monitoring, with only 19.6% of Medicaid beneficiaries with diabetes receiving the recommended HbA1c test during the one-year period after the initial diagnose of diabetes. The mean number of HbA1c tests (~ = 0.33, s.d. .84) did not differ signficantly among Black and Whites. However, multivariate analyses indicated that health care plan and the number of physician visits, and not race, were predictive of the frequency of blood glucose monitoring. GBHC beneficiaries were nearly one-and-half times more likely to have had at least one HbA1c test than FFS beneficiaries (relative risk 1.40, 95% confidence interval 1.14-1.73). The likelihood of beneficiaries having a HbA1c test increased three-fold with 3 or more physician visits. Conclusions: GHBC has improved diabetes care quality relative FFS as indicated by modest improvements in blood glucose monitoring. However, GBHC, currently the only primary health plan option under Medicaid, had not achieved diabetes care quality standards for its beneficiaries. Implications for Practice and Policy: The results are indicative of system-level changes and the patient-provider interactions in improving healthcare quality. Quality improvement efforts which encourage more visits to their primary care providers, regardless of plan type, will improve diabetes care standard for Black and White Medicaid beneficiaries.

Learning Objectives:

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

[ Recorded presentation ] Recorded presentation

Eliminating Health Disparities: Findings From Research Conducted By HBCU Investigators

The 132nd Annual Meeting (November 6-10, 2004) of APHA