title: Continuity and quality of care for children with diabetes who are covered by medicaid.
abstract: BACKGROUND
  Poor and minority children with Type 1 diabetes mellitus are at increased risk of severe adverse outcomes as a result of their disease. However, little is known about the quality of care that these children receive and which factors are associated with better quality of care.
  
  
  OBJECTIVE
  Our objectives were as follows: 1) to describe the utilization of services associated with quality of care for children with Type 1 diabetes mellitus who are covered by Medicaid and 2) to test the hypothesis that increased continuity of primary care is associated with better care for these children.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Washington State Medicaid claims data for 1997 were used to determine what proportion of children with diabetes had 1) an inpatient or outpatient diagnosis of diabetic ketoacidosis (DKA), 2) a glycosylated hemoglobin (HgA1c) level that had been checked, 3) a retinal examination, and 4) thyroid function studies. Continuity of care was quantified using a pre-established index.
  
  
  RESULTS
  Two hundred fifty-two eligible patients were identified. During the observation year, 20% had an outpatient diagnosis of DKA, 6% were admitted with DKA, 43% visited an ophthalmologist, 54% had their HgA1c checked, and 21% had their thyroid function assessed. Children with high continuity of care were less likely to have DKA as an outpatient (0.30 [0.13-0.71]). Children with medium continuity of care and high continuity of care were less likely to be hospitalized for DKA (0.22 [0.05-0.87] and 0.14 [0.03-0.67], respectively). For preventive services utilization, high continuity of care was associated only with an increased likelihood of visiting an ophthalmologist (2.80 [1.08-3.88]).
  
  
  CONCLUSIONS
  The quality of care for Medicaid children with diabetes can be substantially improved. Low continuity of primary care is an identifiable risk factor for DKA.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA 98103-8652, USA. dachris@u.washington.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Christakis
authors.forename: C
authors.initials: C
authors.lastname: Feudtner
authors.forename: C
authors.initials: C
authors.lastname: Pihoker
authors.forename: F A
authors.initials: FA
authors.lastname: Connell
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000592:standards*; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000191:economics / Q000592:standards*; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000592:standards*; D016017:Odds Ratio; D010372:Pediatrics / Q000191:economics / Q000592:standards*; D011336:Probability; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014861:Washington