Disability and Health Journal
Volume 3, Issue 3 , Pages 179-185, July 2010

Quality of diabetes care for adults with developmental disabilities

  • Theresa I. Shireman, Ph.D.

      Affiliations

    • Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS 66160, USA
    • Corresponding Author InformationCorresponding author: 3901 Rainbow Blvd., MSN 1008. Fax (913) 588-2780.
  • ,
  • Amanda Reichard, Ph.D.

      Affiliations

    • Research and Training Center on Independent Living, University of Kansas, Kansas City, KS 66045, USA
  • ,
  • Niaman Nazir, M.B.B.S., M.P.H.

      Affiliations

    • Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS 66160, USA
  • ,
  • James M. Backes, Pharm.D.

      Affiliations

    • Department of Pharmacy Practice, University of Kansas School of Pharmacy, Kansas City, KS 66160, USA
  • ,
  • K. Allen Greiner, M.D., M.P.H.

      Affiliations

    • Department of Family Medicine, University of Kansas School of Medicine, Kansas City, KS 66160, USA

published online 11 December 2009.

Abstract 

Background

Given that individuals with developmental disabilities have a history of difficulty accessing appropriate health care, possess numerous risk factors for diabetes, and frequently have unique needs within the health care setting, it is important to conduct surveillance research to determine the quality of their diabetes care.

Objective/Hypothesis

We assessed the quality of diabetes care for adults with developmental disabilities enrolled in Kansas Medicaid. Developmental disability was defined in accordance with Kansas Medicaid program eligibility and included individuals with intellectual disability, cerebral palsy, autism, and/or seizure disorder.

Methods

We identified a retrospective cohort of persons with developmental disabilities who were also diabetic and continuously enrolled in Kansas Medicaid. We tracked their quality of care measures (HbA1c/glucose testing, cholesterol testing, eye examinations, microalbuminaria screening, and primary care visits) across the subsequent 12 months. Quality care measures were evaluated in relation to basic demographic variables and comorbid hypertension using unconditional logistic regression.

Results

Among 5,960 adults with developmental disability, 666 had diabetes (11.2%). Annual testing rates were HbA1c/glucose testing, 51.7%; cholesterol, 44.3%; eye examinations, 29.3%; and microalbuminaria, 18.5%. Nearly all (93.5%) had contact with a primary care provider during the period. Comorbid hypertension was associated with higher rates of HbA1c, cholesterol testing, and primary care visits. Dual eligibility was associated with lower HbA1c/glucose testing and cholesterol testing rates but comparable rates for other measures. Caucasians were more likely to have had an eye examination but less likely to have had their microalbumin checked.

Conclusions

Adults with developmental disabilities and diabetes who were enrolled in the Kansas Medicaid Program were screened at lower frequency than published national figures for key quality indicators of diabetes care. These results call for action to find approaches to improve their quality of care. Further work is needed to understand the barriers to appropriate care and incentives that will remedy these gaps. In addition, research is needed to determine the accuracy of diabetes identification, treatment, and monitoring of adults with developmental disabilities.

Keywords: Developmental Disabilities, Diabetes care, Medicaid, Quality of care

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 Financial disclosure: Aside from the federal funding from CMS provided through a subcontract between our institution and KHPA, none of the authors have any potential conflicts of interest, financial or otherwise, to report. This project was funded by a Centers for Medicare and Medicaid (CMS) Medicaid Transformation Grant provided to KHPA with a subcontract to KUMC: Health Promotion for Persons with Disabilities. The results do not necessarily reflect the opinions or policy of KHPA or any state or federal governmental agency.

PII: S1936-6574(09)00188-5

doi:10.1016/j.dhjo.2009.10.004

Disability and Health Journal
Volume 3, Issue 3 , Pages 179-185, July 2010