Abstract
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.
Keywords
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Article Info
Publication History
Published online: March 09, 2017
Accepted:
October 28,
2016
Received:
May 2,
2016
Footnotes
Conflict of Interest: The authors declare that they have no conflict of interest.
Identification
Copyright
© 2016 by Academic Pediatric Association
