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Published on: January 29, 2014
Quality of Primary Care for Children With Disabilities Enrolled in Medicaid
Alyna T Chien1, Karen A Kuhlthau2, Sara L Toomey1
1Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
Insights
Primary care for Medicaid children with disabilities (CWD) is suboptimal, with quality below 50% for many measures. Improvements are needed in preventive, acute, and chronic care for these vulnerable children.
Area of Science:
- Pediatric Health Services Research
- Health Disparities
- Healthcare Quality
Background:
- The quality of primary care for children with disabilities (CWD) insured by Medicaid is not well understood.
- A validated algorithm (CWDA) is now available to identify CWD within large datasets.
Purpose of the Study:
- To determine the prevalence of CWD among Medicaid enrollees.
- To assess the quality of primary care received by CWD.
- To compare primary care quality between CWD and non-CWD.
Main Methods:
- A cross-sectional study used 2008 Medicaid claims data from 9 states.
- The Children with Disabilities Algorithm (CWDA) identified CWD (1-18 years old).
- Twelve pediatric quality measures assessed preventive, acute, and chronic care, comparing CWD to non-CWD.
Main Results:
- CWD represented 5.3% of the Medicaid population.
- Primary care quality for CWD was below 50% on 8 of 12 measures.
- CWD care quality was slightly better on 9 measures but worse on chlamydia screening and asthma ED visits compared to non-CWD.
Conclusions:
- Approximately 1 in 20 Medicaid children have disabilities, and their primary care quality is suboptimal.
- Key areas for improvement include preventive/screening, acute care, and chronic disease management for CWD.
- Quality differences between CWD and non-CWD varied depending on comparison groups.
Objective:
The quality of primary care delivered to Medicaid-insured children with disabilities (CWD) is unknown. We used the newly validated CWD algorithm (CWDA) to examine CWD prevalence among Medicaid enrollees 1 to 18 years old, primary care quality for CWD, and differences in primary care quality for CWD and non-CWD.
Methods:
Cross-sectional study using 2008 Medicaid Analytic eXtract claims data from 9 states, including children with at least 11 months of enrollment (N = 2,671,922 enrollees). We utilized CWDA to identify CWD and applied 12 validated or endorsed pediatric quality measures to assess preventive/screening, acute, and chronic disease care quality. We compared quality for CWD and non-CWD unmatched and matched on age, sex, and number of nondisabling chronic conditions and outpatient encounters.
Results:
CWDA identified 5.3% (n = 141,384) of our study population as CWD. Care quality levels for CWD were below 50% on 8 of 12 quality measures (eg, adolescent well visits [44.9%], alcohol/drug treatment engagement [24.9%]). CWD care quality was significantly better than the general population of non-CWD by +0.9% to +15.6% on 9 measures, but significantly worse for 2 measures, chlamydia screening (-3.4%) and no emergency department visits for asthma (-5.0%; all P < .01 to .001). Differences in care quality between CWD and non-CWD were generally smaller or changed direction when CWD were compared to a general population or matched group of non-CWD.
Conclusions:
One in 20 Medicaid-insured children is CWD, and the quality of primary care delivered to CWD is suboptimal. Areas needing improvement include preventive/screening, acute care, and chronic disease management.
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