Planning and policy development for providing quality of care and reducing admissions for high risk diabetic children: The impact of Medicaid managed care

BACKGROUND: Approximately 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: Community health planners and providers 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. If not, they will need to advocate specific program/policy reforms to improve the structure of care.