Medicaid managed care impacts on quality of care and readmissions for high risk diabetic children

Background: As many as 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: Primary care and public health organizations 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. Other states may provide viable models for emulation for those states not effectively managing care.