Continuity and quality of care for children with diabetes who are covered by medicaid

Background.- Poor and minority children with Type I diabetes mellitus are a t increased risk of severe adverse outcomes as a result of their disease. H owever, little is known about the quality of care that these children recei ve and which factors are associated with better quality of care. Objectives.- Our objectives were as follows: 1) to describe the utilization of services associated with quality of care for children with Type 1 diabe tes mellitus who are covered by Medicaid and 2) to test the hypothesis that increased continuity of primary care is associated with better care for th ese children. Design.- Retrospective cohort study. Methods.- Washington State Medicaid claims data for 1997 were used to deter mine what proportion of children with diabetes had 1) an inpatient or outpa tient diagnosis of diabetic ketoacidosis (DKA), 2) a glycosylated hemoglobi n (HgAlc) level that had been checked, 3) a retinal examination, and 4) thy roid function studies. Continuity of care was quantified using a pre-establ ished index. Results.- Two hundred fifty-two eligible patients were identified. During t he observation year, 20% had an outpatient diagnosis of DKA, 6% were admitt ed with DKA, 43% visited an ophthalmologist, 54% had their HgAlc checked, a nd 21% had their thyroid function assessed. Children with high continuity o f care were less likely to have DKA as an outpatient (0.30 [0.13-0.71]). Ch ildren with medium continuity of care and high continuity of care were less likely to be hospitalized for DKA (0.22 [0.05-0.87] and 0.14 [0.03-0.67], respectively). For preventive services utilization, high continuity of care was associated only with an increased likelihood of visiting an ophthalmol ogist (2.80 [1.08-3.88]). Conclusions.- The quality of care for Medicaid children with diabetes can b e substantially improved. Low continuity of primary care is an identifiable risk factor for DKA.