Abstract
Objective:
To evaluate indicators of diabetes quality of care for US non-elderly, adult Medicaid enrollees with type 2 diabetes and compare federally qualified health centers (FQHC) vs. non-FQHCs.
Research Design and Methods:
We analyzed diabetes process measures and acute health services utilization with 2012 US fee-for-service and managed care Medicaid claims in all 50 states and DC. We compared FQHC (N=121,977) to non-FQHC patients (N=700,401) using propensity scores to balance covariates and generalized estimating equation models.
Results:
Overall laboratory-based process measures occurred more frequently (range, 65.7%−76.6%) than measures requiring specialty referrals (retinal exams, 33.3%; diabetes education, 3.4%). Compared to non-FQHC patients, FQHC patients had about three percentage point lower rates of each process measure, except for higher rates of diabetes education (relative risk [RR] 1.09 [95% CI 1.03–1.16]). FQHC patients had fewer overall (incident rate ratio [IRR] 0.87 [95% CI 0.86–0.88]) and diabetes-related hospitalizations (IRR 0.79 [95% CI 0.77–0.81]), but more overall (IRR 1.06 [95% CI 1.05–1.07]) and diabetes-related emergency department (ED) visits (IRR 1.10 [95% CI 1.08–1.13]).
Conclusions:
This national analysis identified opportunities to improve diabetes management among Medicaid enrollees with type 2 diabetes, especially for retinal exams or diabetes education. Overall, we found slightly lower rates of most diabetes care process measures for FQHC patients vs. non-FQHC patients. Despite having higher rates of ED visits, FQHC patients were significantly less likely to be hospitalized than non-FQHC patients. These findings emphasize the need to identify innovative, effective approaches to improve diabetes care for Medicaid enrollees, especially in FQHC settings.
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