Research Paper
Quality of diabetes care for adults with developmental disabilities

https://doi.org/10.1016/j.dhjo.2009.10.004Get rights and content

Abstract

Background

Given that individuals with developmental disabilities have a history of difficulty accessing appropriate health care, possess numerous risk factors for diabetes, and frequently have unique needs within the health care setting, it is important to conduct surveillance research to determine the quality of their diabetes care.

Objective/Hypothesis

We assessed the quality of diabetes care for adults with developmental disabilities enrolled in Kansas Medicaid. Developmental disability was defined in accordance with Kansas Medicaid program eligibility and included individuals with intellectual disability, cerebral palsy, autism, and/or seizure disorder.

Methods

We identified a retrospective cohort of persons with developmental disabilities who were also diabetic and continuously enrolled in Kansas Medicaid. We tracked their quality of care measures (HbA1c/glucose testing, cholesterol testing, eye examinations, microalbuminaria screening, and primary care visits) across the subsequent 12 months. Quality care measures were evaluated in relation to basic demographic variables and comorbid hypertension using unconditional logistic regression.

Results

Among 5,960 adults with developmental disability, 666 had diabetes (11.2%). Annual testing rates were HbA1c/glucose testing, 51.7%; cholesterol, 44.3%; eye examinations, 29.3%; and microalbuminaria, 18.5%. Nearly all (93.5%) had contact with a primary care provider during the period. Comorbid hypertension was associated with higher rates of HbA1c, cholesterol testing, and primary care visits. Dual eligibility was associated with lower HbA1c/glucose testing and cholesterol testing rates but comparable rates for other measures. Caucasians were more likely to have had an eye examination but less likely to have had their microalbumin checked.

Conclusions

Adults with developmental disabilities and diabetes who were enrolled in the Kansas Medicaid Program were screened at lower frequency than published national figures for key quality indicators of diabetes care. These results call for action to find approaches to improve their quality of care. Further work is needed to understand the barriers to appropriate care and incentives that will remedy these gaps. In addition, research is needed to determine the accuracy of diabetes identification, treatment, and monitoring of adults with developmental disabilities.

Section snippets

Methods

We conducted a retrospective cohort analysis for quality of care measures among adult (ages 18 to 65 years) persons with developmental disabilities who had diabetes and who were enrolled in the Kansas Medicaid Aged, Blind and Disabled (ABD) Program. Kansas Medicaid provides long-term care, inpatient, outpatient, pharmacy, and hospice coverage to adults with disabilities who qualify for Supplemental Security Income (SSI), are Medically Needy, are qualified Medicare beneficiaries, or are severely

Results

There were 5,930 persons with developmental disabilities and continuous enrollment in the Kansas Medicaid program during the 12-month monitoring period. The prevalence of diabetes was 11.2% (666 persons identified as having diabetes based on prior claims). Their mean age was 43.1 years with over half of the cohort between 31 and 50 years of age (Table 2): the mean age of those with diabetes was approximately 8 years older than the overall cohort. The majority was Caucasian (86.5%), and males

Discussion

Adults with developmental disabilities and diabetes who were enrolled in the Kansas Medicaid ABD program were screened less frequently for key quality indicators of diabetes care in the course of 12 months than rates reported for overall Medicaid programs. HbA1c/glucose was assessed in just over 50% of the study population, while NCQA data indicate a much higher rate of strictly HbA1c monitoring in those with commercial and Medicare health plans (>88%), and among all Medicaid enrollees (77%).

Conclusions

The results presented provide an important insight into the utilization of quality of care measures for diabetes among persons with developmental disabilities enrolled in Kansas Medicaid. Collectively these data suggest markedly lower rates of quality of diabetes care measures in those with developmental disabilities compared with published national rates. These findings generate a number of concerns regarding the health of this population with potential economic implications. The basis of

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    Financial disclosure: Aside from the federal funding from CMS provided through a subcontract between our institution and KHPA, none of the authors have any potential conflicts of interest, financial or otherwise, to report. This project was funded by a Centers for Medicare and Medicaid (CMS) Medicaid Transformation Grant provided to KHPA with a subcontract to KUMC: Health Promotion for Persons with Disabilities. The results do not necessarily reflect the opinions or policy of KHPA or any state or federal governmental agency.

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