Online Program

Planning and policy development for providing quality of care and reducing admissions for high risk diabetic children: The impact of Medicaid managed care

Monday, November 4, 2013

Kathleen Healy-Collier, DHA, Medical University of South Carolina, LeBonheur Children's Hospital/Regional Medical Center, Cordova, TN
Walter Jones, PhD, Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
Jim Shmerling, DHA, Children's Hospital Colorado, Aurora, CO
Kenneth Robertson, MD, MBA, LeBonheur Children's Hospital, Memphis, TN
Robert Ferry, MD, Division of Pediatric Endocrinology, Univerisity of Tennessee and Le Bonheur Children's Hospital, Memphis, TN
BACKGROUND: Approximately three million individuals had Type I diabetes in the United States in 2011. With Medicaid program variations, there are potentially large differences in access and quality of care for child diabetics. However, no previous studies have holistically assessed the impact of Medicaid managed care on juvenile diabetic treatment. METHODS: This study used a retrospective four year cross-sectional design with Children's Hospital Association PHIS data from 43 hospitals in 26 states, including 4,762 patients with 12,104 qualifying admissions, to determine whether juvenile onset diabetic patients are more or less likely to be readmitted with uncontrolled diabetes if they are on a Medicaid managed care plan. Multiple factors for readmission were analyzed including age, race, gender, severity of illness (APR-DRG), patient type on discharge, and state. RESULTS: Simple readmission rates by state ranged from 4.08% to 24.82 %. The relationship between state and days between readmissions was significant (P<.0001). Logistic regression revealed that overall readmission was more likely for Medicaid patients on non-managed care plans than for those on managed care (Chi-Square 4.3, P = 0.0373), and that those on non-managed care plans were 1.12 times more likely to be readmitted. CONCLUSIONS: Community health planners and providers need to examine their state's Medicaid care structure and consider whether or not it is engaging in “best practices” for pediatric diabetic patients, so as to provide the best possible framework for effective service delivery. If not, they will need to advocate specific program/policy reforms to improve the structure of care.

Learning Areas:

Chronic disease management and prevention
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Evaluate the differences in health care access and quality between Medicaid managed care versus non-Medicaid managed care for high risk diabetic children Analyze how state Medicaid policies might be better developed to improve health care access and quality for high risk diabetic children

Keyword(s): Children With Special Needs, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary researcher on the abstract topic (Medicaid managed care impacts on high risk diabetic children) and work in a health care facility that treats the clients under study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.