title: Quality of Primary Care for Children With Disabilities Enrolled in Medicaid.
abstract: The quality of primary care delivered to Medicaid-insured children with disabilities (CWD) is unknown. We used the newly validated CWD algorithm (CWDA) to examine CWD prevalence among Medicaid enrollees 1 to 18 years old, primary care quality for CWD, and differences in primary care quality for CWD and non-CWD.
  
  
  
  Cross-sectional study using 2008 Medicaid Analytic eXtract claims data from 9 states, including children with at least 11 months of enrollment (N = 2,671,922 enrollees). We utilized CWDA to identify CWD and applied 12 validated or endorsed pediatric quality measures to assess preventive/screening, acute, and chronic disease care quality. We compared quality for CWD and non-CWD unmatched and matched on age, sex, and number of nondisabling chronic conditions and outpatient encounters.
  
  
  
  CWDA identified 5.3% (n = 141,384) of our study population as CWD. Care quality levels for CWD were below 50% on 8 of 12 quality measures (eg, adolescent well visits [44.9%], alcohol/drug treatment engagement [24.9%]). CWD care quality was significantly better than the general population of non-CWD by +0.9% to +15.6% on 9 measures, but significantly worse for 2 measures, chlamydia screening (-3.4%) and no emergency department visits for asthma (-5.0%; all P < .01 to .001). Differences in care quality between CWD and non-CWD were generally smaller or changed direction when CWD were compared to a general population or matched group of non-CWD.
  
  
  
  One in 20 Medicaid-insured children is CWD, and the quality of primary care delivered to CWD is suboptimal. Areas needing improvement include preventive/screening, acute care, and chronic disease management.
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: alyna.chien@childrens.harvard.edu.
authors.forename: Alyna T
authors.initials: AT
authors.lastname: Chien
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Mass; Center for Child and Adolescent Health Research and Policy, Department of General Pediatrics, Massachusetts General Hospital for Children, Boston, Mass.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Kuhlthau
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Toomey
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Quinn
authors.affiliation: Division of General Pediatrics, University of California San Francisco Beinoff Children's Hospital, San Francisco, Calif; Division of General Pediatrics, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, Calif.
authors.forename: Megumi J
authors.initials: MJ
authors.lastname: Okumura
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Ark.
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.affiliation: Division of Pediatric Rehabilitation Medicine, Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Houtrow
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Mass; Center for Child and Adolescent Health Research and Policy, Department of General Pediatrics, Massachusetts General Hospital for Children, Boston, Mass.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Van Cleave
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Mass.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.affiliation: The Clinical Research Center, Boston Children's Hospital, Boston, Mass.
authors.forename: Jisun
authors.initials: J
authors.lastname: Jang
authors.affiliation: Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Isabel
authors.initials: I
authors.lastname: Janmey
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Furdyna
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D000293:Adolescent; D001130:Arizona; D002648:Child; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019988:Children with Disabilities; D005260:Female; D006801:Humans; D007196:Indiana; D007223:Infant; D007615:Kansas; D007629:Kentucky; D008297:Male; D008484:Medicaid; D008923:Missouri; D009515:New Jersey; D009516:New Mexico; D010372:Pediatrics / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D014481:United States; D014768:Virginia; D014922:Wisconsin
keywords: Medicaid; children; disabilities; pediatrics; quality of care