Assessment of care for individuals with type 2 diabetes among Indiana Medicaid beneficiaries
This study was undertaken to determine the proportion of Indiana Medicaid beneficiaries who received each of six diabetes care assessments consistent with recommendations in American Diabetes Association guidelines and to assess associations between Medicaid subprogram and likelihood of receiving each of the diabetes care assessments. A retrospective analysis was conducted using Indiana Medicaid eligibility and claim files for the period January 1, 2006 to December 31, 2007. A total 22,017 recipients with type 2 diabetes were included in the study sample. The majority of the sample was 45 years or older, female, or Caucasian. The proportions of individuals who met each of the American Diabetes Association recommendations were: 63.5 percent for serum creatinine tests, 37.2 percent for lipid tests, 30.5 percent for eye examinations, 23.3 percent for microalbuminuria tests, 18.2 percent for influenza vaccinations, and 15.6 percent for glycosylated hemoglobin (A1C) tests. However, rate of receiving A1C tests may under represent the actual rates since some clinics conduct A1C tests on site and do not submit separate claim to Indiana Medicaid for such tests. A significant proportion of the Medicaid recipients, 22 percent, did not receive any of the six diabetes care assessments during the study interval. Only 1.3 percent of the study population received all six diabetes care assessments. Logistic regression was used to assess association between being in a specific Medicaid subprogram and likelihood of receiving diabetes care assessments. The unadjusted likelihood of receiving diabetes care assessments was highest in Medicaid/Care Select, followed by Hoosier Healthwise, and Traditional Medicaid. After controlling for age, gender, ethnicity, Charlson Comorbidity Index score, and state Medicaid geographic region, recipients in Medicaid/Care Select were still more likely to receive all diabetes care assessments than those in Traditional Medicaid, including A1C tests (OR = 3.82, p < 0.001), lipid tests (OR = 4.74, p < 0.001), eye examinations (OR = 1.38, p = 0.001), microalbuminuria tests (OR = 2.64, p < 0.001), serum creatinine tests (OR= 3.24, p < 0.001), and influenza vaccinations (OR = 1.93, p < 0.001). Recipients in Hoosier Healthwise also were more likely than those in Traditional Medicaid to receive each assessment with the exception of eye examinations after adjusting for potential covariates. Those in Hoosier Healthwise were more likely than those in Traditional Medicaid to receive recommended A1C tests (OR = 3.37, p < 0.001), lipid tests (OR = 3.78, p < 0.001), microalbuminuria tests (OR = 2.26, p < 0.001), serum creatinine tests (OR = 2.00, p < 0.001), and influenza vaccinations (OR = 1.39, p < 0.001). Variation in subprogram characteristics such as enrollment in Indiana Chronic Disease Management Program and primary care provider system could be responsible for some of the differences in level of diabetes care received by individuals. If so that may indicate the disease management program or primary care gatekeeper entity are effective in increasing the level of assessments among recipients. ^
Kimberly S. Plake, Purdue University, Joseph Thomas, Purdue University.
Health Sciences, Public Health|Health Sciences, Health Care Management