Adherence to guidelines for and disparities in diabetes care utilization in Medicaid children.
1999-2002 Medicaid administrative data on 360 children with diabetes mellitus were used to study disparities in and utilization of health care in Missouri, United States. Measures of ambulatory care and its utilization were based on clinical guidelines. Their association with readmission in hospitals and emergency rooms were examined using multivariate analyses. Many children did not visit their doctor's office, have blood tests for glycosylated hemoglobin, or monitor their blood glucose level. There were no sex or race differences in the utilization of ambulatory care or its outcome for all children, except for blood glucose test strip use. Older age and non-white race increased the odds of rehospitalization and three or more physician encounters decreased this risk. Non-white race increased the odds of visiting emergency rooms. In some subpopulations, there were age, sex, and race disparities in ambulatory care utilization. Adherence to diabetes care guidelines was associated with lower risk of re-hospitalization.
U. S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Kansas City, MO 64106, USA. kazim.sheikh@cms.hhs.gov
Kazim
K
Sheikh
Claudia M
CM
Bullock
Yanming
Y
Jiang
Stephen D
SD
Ketner
D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008484:Medicaid / Q000592:standards; D017410:Practice Guidelines as Topic; D013221:State Health Plans / Q000706:statistics & numerical data; D014481:United States