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Preventive care for chronically ill children in medicaid managed care.

OBJECTIVES
To determine whether there is an association between the quality of child preventive care received and the existence of 1 or more chronic conditions.


STUDY DESIGN
A retrospective study of all New York State children and adolescents enrolled in Medicaid managed care in 2008.


METHODS
Using a cohort identified through mandatory annual quality reporting, a clinical algorithm was applied to administrative data to assign children to 3 health status levels: healthy/ acute, minor chronic, and significant chronic. We performed bivariate and logistic regression analyses to compare the quality of care received by these 3 groups on 10 child-relevant preventive care services.


RESULTS
One-fourth of the children in our cohort were deemed to have either minor or significant chronic health conditions. Children with chronic conditions generally had a higher or equal probability of receiving recommended preventive care compared with healthy or acutely ill children, even after controlling for member characteristics. For those services where children with chronic conditions were significantly more likely to receive a preventive care service, the risk ratios ranged from 1.03 to 1.11 for minor chronic children and from 1.03 to 1.17 for significant chronic children.


CONCLUSIONS
The quality of preventive health care for children with chronic conditions in New York State Medicaid managed care is equivalent to or better than that for healthy or acutely ill children. Investigating quality concerns for subpopulations of members by combining existing standardized quality measures with administrative health status data is a useful tool for informing state quality-improvement initiatives.