Medicaid Managed Care Reduces Readmissions for Youth with Type 1 Diabetes

Medicaid Managed Care Reduces Readmissions for Youth with Type 1 Diabetes

 

Running title: Reducing Pediatric T1D Readmissions

 

Analysis of the largest cohort available reveals youth with T1D on Medicaid managed care are less likely to be readmitted within 90 days of discharge.

 

Take Away Points

 

This large national study of 42 free-standing children’s hospitals across 26 states compared youth with T1D on Medicaid insurance who received a managed care product vs. peers who did not. Key findings were:

 

•     Youth with T1D on Medicaid managed care were less likely to be readmitted within 90 days, adjusting for severity, despite similar rates of DKA.

•     States displayed wide variation in overall readmission rates for diabetes and those presenting in DKA.

•     Policy makers should build on specific successes with the use of managed care tools (e.g., case management, health information technology) to reduce preventable readmissions related to pediatric T1D.

 

 

10 pages, 2703 words, 47 references, 3 tables

Abstract: 

OBJECTIVE: To determine whether likelihood of readmission (adjusted for severity on first admission) for pediatric type 1 diabetes (T1D) differs between Medicaid managed care and non-managed care.

STUDY DESIGN: De-identified patients were retrospectively selected from the Pediatric Health Information Systems (PHIS) database of the Children’s Hospital Association (CHA). Cohort of 42 hospitals across 26 states included discharges between 2008-11 who were receiving Medicaid at the time of service and had T1D as their diagnosis.

METHODS: Multiple factors and co-variants for readmission were analyzed by logistic regression, including age, race, gender, severity of illness, and state of admission.

RESULTS: Of 14,544 T1D discharges with Medicaid, 4,985 were readmitted, including 1,792 readmitted for diabetic ketoacidosis (DKA). Despite similar rates of DKA between the managed care and non-managed care cohorts, overall readmission was 1.12 times more likely for Medicaid patients on non-managed care plans than those on managed care (c2=4.3, P<0.04), and significant contributors were race (P<0.0001), age (P<0.0001), and gender (P<0.03). The relationship of state and days between readmissions was significant (P<0.0001). Conservative estimate of cost reduction from Medicaid managed care related to lower readmission rate for pediatric T1D across CHA institutions between 2008-11 was $2.6 million.

CONCLUSION: From the largest, national, defined cohort available for contemporary study, youth with T1D on Medicaid managed care plans were less likely to be readmitted within 90 days of discharge.

This publication has been peer reviewed.
Publication Type: 
Journal Article
Authors: 
Kathleen Healy-Collier
Dr. Bob Ferry
Dr. Ken Robertson
Dr. Walter Jones
Year of Publication: 
2016
Journal, Book, Magazine or Other Publication Title: 
American Journal Of Managed Care
Volume: 
2015-02-0049.R2
Publisher: 
AJMC
Date Published: 
Friday, February 5, 2016
Place Published: 
AJMC
Publication Language: 
English
ISSN Number: 
TBD
ISBN Number: 
TBD
Editors: 
AJMC
Boyer's Domain: 

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