Diabetes Experience of Iowans with IDD Funding through the CDC ‘ Improving the Health of People with Mobility Limitations and Intellectual Disabilities through State‐based Public Health Programs ’ November 12, 2020 I have no financial relationships to disclose.
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Diabetes in Iowa General population rates – Based on CDC data BRFSS Medicaid rates – Based on Medicaid claims data
Diabetes rates in Iowa 40% 35% 30% 25% y = 0.0028x + 0.1921 20% y = -4E-05x + 0.1445 15% y = 0.0003x + 0.0846 10% y = -0.0002x + 0.0434 5% 0% 2011 2012 2013 2014 2015 2016 2017 2018 35-44 years 45-54 years 55-64 years Over 65 Linear (35-44 years) Linear (45-54 years) Linear (55-64 years) Linear (Over 65) Public Policy Center
Short- and long-term complications per 100,000 Iowa Medicaid members 350 300 250 y = -37.385x + 324.4 200 150 y = -0.993x + 91.08 100 y = -0.642x + 40.745 50 y = 10.551x - 3.26 0 2015 2016 2017 2018 Diabetes short-term complications Diabetes long-term complications Uncontrolled diabetes Lower-extremity amputation Linear (Diabetes short-term complications) Linear (Diabetes long-term complications) Linear (Uncontrolled diabetes) Linear (Lower-extremity amputation ) View >> Header and Footer >> Add Unit Name
Hemoglobin A1c 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2015 2016 2017 2018 Iowa US Public Policy Center
Eye exam 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2015 2016 2017 2018 Iowa US Public Policy Center
Care for nephropathy 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2015 2016 2017 2018 Iowa US Public Policy Center
Improving the Health of People with Mobility Limitations and Intellectual Disabilities through State‐based Public Health Programs Description of project View >> Header and Footer >> Add Unit Name
Project goals Ensure people with disabilities have the same opportunities for good health as people without disabilities • Utilize data to explore the health care experiences of people with disabilities • Identify areas of concern or difference to address • Determine mechanisms to improve opportunities for good health
Current states Arkansas Iowa Kansas Massachusetts Michigan Montana New Hampshire New York Oregon South Carolina View >> Header and Footer >> Add Unit Name
People with disabilities Medicaid claims and enrollment data 5-year look back Adults 18-64 Identified ‘disabilities’ Down Syndrome Cerebral Palsy Autism Intellectual Disability Unspecific Intellectual Disability View >> Header and Footer >> Add Unit Name
Diabetes definition 1. Claim/encounter data. Members who met any of the following criteria during the measurement year or the year prior to the measurement year (count services that occur over both years): At least two outpatient visits (Outpatient Value Set), observation visits (Observation Value Set) or nonacute inpatient encounters (Nonacute Inpatient Value Set) on different dates of service, with a diagnosis of diabetes (Diabetes Value Set). Visit type need not be the same for the two visits. At least one acute inpatient encounter (Acute Inpatient Value Set) with a diagnosis of diabetes (Diabetes Value Set). At least one ED visit (ED Value Set) with a diagnosis of diabetes (Diabetes Value Set). 2. Pharmacy data . Members who were dispensed insulin or hypoglycemics/ antihyperglycemics on an ambulatory basis during the measurement year or the year prior to the measurement year (Table CDC-A). View >> Header and Footer >> Add Unit Name
Comprehensive Diabetes Care (CDC) HEDIS measures set 2014 Product Commercial, Medicaid, Medicare (report each product line lines separately). Ages 18–75 years as of December 31 of the measurement year. Continuous The measurement year. enrollment No more than one gap in enrollment of up to 45 days during the measurement year. To determine continuous enrollment for a Allowable Medicaid beneficiary for whom enrollment is verified monthly, the gap member may not have more than a 1-month gap in coverage (i.e., a member whose coverage lapses for 2 months [60 days] is not considered continuously enrolled). Anchor date December 31 of the measurement year. View >> Header and Footer >> Add Unit Name
CDC individual measures Hemoglobin A1c (HbA1c) testing LDL-C screening HbA1c poor control (>9.0%) LDL-C control (<100 mg/dL) HbA1c control (<8.0%) Medical attention for nephropathy HbA1c control (<7.0%) for a selected population* BP control (<140/80 mm Hg) Eye exam (retinal) performed BP control (<140/90 mm Hg) View >> Header and Footer >> Add Unit Name
Chosen measures Hemoglobin A1c (HbA1c) testing Eye exam (retinal) performed LDL-C screening Medical attention for nephropathy View >> Header and Footer >> Add Unit Name
Comparison across IDD categories 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HbA1c Retinal Exam LDL-C Screening Medical Attention for Nephropathy Total Down Syndrome and other Genetic Conditions Cerebral Palsy Autism/ PDD Mild Intellectual Disability Moderate to Profound Intellectual Disability Unspecified Intellectual Disability View >> Header and Footer >> Add Unit Name
Compared to non-IDD 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HbA1c Retinal Exam LDL-C Screening Medical Attention for All 4 Nephropathy IDD non-IDD View >> Header and Footer >> Add Unit Name
Compared to other states* 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% HbA1c Retinal Exam LDL-C Screening Medical Attention for All 4 Nephropathy Iowa Massachusetts New York Oregon South Carolina * Disparities in diabetes management among Medicaid recipients with intellectual and developmental disabilities (IDD): Evidence from five U.S. states, Lu, et al. Disability and Health Journal, 13(2020) View >> Header and Footer >> Add Unit Name
Programmatic action! Program staff developed state-based PSA – Watch Party! Iowa https://youtu.be/8lR1KzNrxBU South Carolina https://youtu.be/zJTVp27_KMs View >> Header and Footer >> Add Unit Name
Other studies Emergency room use Epilepsy treatment in the emergency department Preventive care utilization Injuries/falls presenting to the emergency department View >> Header and Footer >> Add Unit Name
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