Quality of care associated with common chronic diseases in a 9-state Medicaid population utilizing claims data: an evaluation of medication and health care use and costs

Abstract

The objective of this cross-sectional, retrospective study was to utilize claims data to establish a quality-of-care benchmark in a large multistate Medicaid population overall and by race. Quality of care and medication adherence (persistence and compliance) per national treatment guidelines, and health care costs/utilization were assessed across common chronic conditions in a large, 9-state Medicaid population. Overall, quality of care was suboptimal across conditions. Over 15% of asthma patients had ≥ 1 asthma-related emergency room/hospital event and 12% of chronic obstructive pulmonary disease patients had a Level II or III exacerbation. Only 36% of depression patients filled any antidepressant medication within 90 days of new episode. Only 45% of diabetes patients received ≥ 2 A1c tests. Patients who filled a prescription for any acceptable pharmacotherapy ranged from 35% (depression) to 83% (heart failure [HF]). Persistence for those filling any acceptable medication ranged from 16% (asthma) to 68% (HF). Compliance for patients filling ≥ 2 prescriptions ranged from 27% (asthma) to 75% (HF). Blacks had the lowest medication compliance and persistence for all conditions except hyperlipidemia. The results highlight the need to assess and improve quality across the spectrum of care, both overall and by race.

FIG. 1.

Results on quality measures for asthma, COPD, depression, and diabetes, overall, and by race. *AD is defined as any antidepressant medication fill. COPD, chronic obstructive pulmonary disease; LDL, low-density lipoprotein; SABA, short-acting beta-agonist.

FIG. 2.

Percent of patients filling any acceptable therapy by condition overall and by race. CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; HF, heart failure; HL, hyperlipidemia; HTN, hypertension.

FIG. 3.

Persistence for any acceptable therapy by condition overall and by race. CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; HF, heart failure; HL, hyperlipidemia; HTN, hypertension.

FIG. 4.

Compliance results for any acceptable therapy by condition overall and by race. CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; HF, heart failure; HL, hyperlipidemia; HTN, hypertension.

FIG. 5.

All-cause per-person per-year costs by condition. CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; HF, heart failure; HL, hyperlipidemia; HTN, hypertension.