Quality of Diabetes Care for Adults with Physical Disabilities

Background: Research has demonstrated that individuals with physical disabilities experience greater risk for developing diabetes than those without disabilities; and they are also more likely to encounter disparities in health care access. Objective/Hypothesis: We assessed Kansas Medicaid data to determine the quality of diabetic care individuals with physical disabilities receive. Methods: We selected a continuously eligible cohort of adults with physical disabilities who had diabetes and who received medical benefits through Kansas Medicaid. We examined their quality of care measures (screening for HbA1c/glucose, cholesterol, and microalbuminaria; eye exams; and, primary care visits) in the succeeding year. We also assessed the quality of care measures as they related to demographic variables and comorbid hypertension. Results: More than 42% of the 9,532 adults with physical disabilities had diabetes. They had the following testing rates: HbA1c, 56.9%; cholesterol, 54.2%; eye examinations, 28.9%; and microalbuminaria, 23.2%. Females and those with comorbid hypertension had higher rates for all types of screenings and primary care visits. Dual eligibles had higher rates for HbA1c/glucose testing, cholesterol screening, eye examinations and primary care visits. Non-Caucasians had higher screening rates for HbA1c/Glucose testing and microalbuminaria. Conclusions: Adults with physical disabilities supported by Kansas Medicaid received diabetes quality indicator screenings at lower rates than nationally published Medicaid figures. The inequities in diabetes care signify the need for improvement for individuals with physical disabilities. Further work is needed to identify the specific barriers to care and to address improvements in diabetes management and routine testing specifically for people with physical disabilities.