Racial differences in quality care measurements, medication adherence, healthcare costs and utilization associated with common chronic diseases in a 9-state medicaid population

Introduction:

Federally funded initiatives target Medicaid to improve quality care, however little is known about racial differences in quality care for common diseases in this population.

Methods:

In this retrospective study, conformity to national treatment guidelines, medication persistence (proportion of days covered, PDC ≥80%), compliance (medication possession ratio, MPR ≥80%), healthcare costs and utilization were assessed across chronic conditions in a 9-state Medicaid database (N=2,869,880). Patients with ≥1 condition (asthma, COPD, coronary artery disease, depression, diabetes, heart failure [HF], hyperlipidemia, hypertension) were identified from January 2005 through June 2006. To produce an annual index and assess racial differences, analyses were performed using 2006 data and conducted by total and race (White, Black, Hispanic and Other). Patients were required to have ≥6 months continuous coverage from identification and be eligible on December 31, 2006. Utilization and costs were annualized for patients with <12 months of coverage in 2006.

Results:

Quality care differed by race for asthma, COPD, and depression. Potential uncontrolled asthma was higher in 'Other' patients as measured by ≥4 short-acting beta-agonist fills (ranged from 18% Hispanic to 34% Other) and ≥2 oral corticosteroid fills (11% Black to 16% Other). Hispanic COPD patients experienced the least Level 2 or 3 Exacerbations (13% Hispanic to 21% Other). In newly diagnosed depression, Blacks received lower quality care as measured by ≥3 outpatient visits and an antidepressant fill within 84 days of diagnosis (8% Black to 17% Other). Black patients had the lowest medication adherence across all conditions (persistence: 8% to 60% Black and 16% to 74% Whites; compliance: 20% to 68% Black and 32% to 81% White). Black and Other patients both had 1.5 to 2 times higher disease-related HF and asthma costs than Whites or Hispanic. Except for depression and hyperlipidemia, Black patients spent more per emergency-room visit ($199-$697) than White ($151-$401), Hispanic ($170-$334) or Other ($160-$399). White patients had less disease-related hospitalization cost per visit (White $2,952-$11,891, Black $4,026-$22,799, Hispanic $3,643-$29,832, Other $3,360-$17,167) in all conditions except COPD, depression and hyperlipidemia. Blacks had the highest asthma- and HF-related emergency visits (asthma: 10% Hispanic to 21% Black; HF: 9% Hispanic to 21% Black).

Implications:

Racial differences were found in quality measures, medication adherence, healthcare cost and utilization in the Medicaid population. Research is needed to determine whether these differences indicate racial variance or actual inequality. Results highlight the need for improvement across the continuum of preventative, acute, and follow-up care.