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Medicaid managed care reduces readmissions for youths with type 1 diabetes
Kathleen Healy-Collier, Walter J Jones, James E Shmerling
1858 Madison Ave, MSB 501A, Memphis, TN 38103-3409. E-mail bob@uthsc.edu.
Insights
Children with type 1 diabetes (T1D) on Medicaid managed care plans had lower 90-day readmission rates compared to non-managed care. This suggests managed care may improve outcomes and reduce costs for pediatric T1D patients.
Area of Science:
- Pediatric Endocrinology
- Health Services Research
- Health Economics
Background:
- Type 1 diabetes (T1D) is a chronic condition requiring ongoing management.
- Medicaid managed care programs aim to improve healthcare access and outcomes for eligible populations.
- Readmission rates are a key indicator of healthcare quality and patient outcomes.
Purpose of the Study:
- To compare 90-day readmission rates for pediatric patients with type 1 diabetes (T1D) under Medicaid managed care versus non-managed care.
- To identify factors influencing readmission in this population.
- To estimate the potential cost savings associated with managed care for pediatric T1D.
Main Methods:
- Retrospective analysis of de-identified patient data from the Pediatric Health Information Systems database (2008-2011).
- Inclusion of 42 hospitals across 25 states, focusing on pediatric T1D patients covered by Medicaid.
- Logistic regression analysis to assess readmission likelihood, adjusting for severity of illness, age, race, gender, and other covariates.
Main Results:
- Overall 90-day readmission was 1.12 times more likely for pediatric T1D patients on non-managed care plans compared to managed care.
- Diabetic ketoacidosis (DKA) readmission rates were similar between the two groups.
- Race, age, and gender were significant contributors to readmission; location and days between readmissions were also significant.
Conclusions:
- Pediatric patients with type 1 diabetes (T1D) enrolled in Medicaid managed care plans exhibit lower 90-day readmission rates.
- Managed care appears to be associated with improved outcomes for this vulnerable population.
- The study estimates $2.6 million in potential cost reductions due to lower readmissions under Medicaid managed care.
Objectives:
To determine whether the likelihood of readmission (adjusted for severity on first admission) for pediatric type 1 diabetes (T1D) differs between Medicaid managed care and non-managed care.
Study Design:
De-identified patients were retrospectively selected from the Pediatric Health Information Systems database of the Children's Hospital Association (CHA). The cohort of 42 hospitals across 25 states included discharges between 2008 and 2011 for patients who were receiving Medicaid at the time of service and had T1D as their diagnosis.
Methods:
Multiple factors and co-variants for readmission were analyzed by logistic regression, including age, race, gender, severity of illness, and state of admission.
Results:
Of 14,544 T1D discharges with Medicaid, 4985 were readmitted, including 1792 readmitted for diabetic ketoacidosis (DKA). Despite similar rates of DKA between the managed care and non-managed care cohorts, overall 90-day readmission was 1.12 times more likely for Medicaid patients on non-managed care plans than those on managed care (odds ratio, 1.12; range = 1.04-1.20; both adjusted for severity of illness). Significant contributors were race, age, and gender; the relationship of location (state) and days between readmissions was also significant. The conservative estimate of cost reduction from Medicaid managed care related to lower readmission rate for pediatric T1D across CHA institutions between 2008 and 2011 was $2.6 million.
Conclusions:
From the largest, national, defined cohort available for contemporary study, youths with T1D on Medicaid managed care plans were less likely to be readmitted within 90 days of discharge.
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