U.S. Flag

An official website of the United States government

PQI 01: Diabetes Short-Term Complications Admission Rate

Without access to high quality outpatient diabetes care, certain diabetes conditions can become life-threatening. These complications may result in costly and avoidable inpatient hospital admissions. Inpatient hospital admissions for these complications can be an indicator that diabetes is not being properly prevented or managed.

Explore inpatient hospital admissions for short-term diabetes complications. Lower rates are better.

The purple dashed line represents the median, or middle of all values reported.

This measure reports inpatient hospital admissions for short-term diabetes complications, including:

  • Diabetic ketoacidosis
  • Hyperosmolarity
  • Coma

The measure is the rate of admissions per 100,000 beneficiary-months for adults age 18 and older.

This measure aligns with the Centers for Disease Control and Prevention’s 6|18 Initiative focus on providing appropriate diabetes care. The 6|18 Initiative focuses on six common and costly health conditions or health behaviors and highlights evidence-based interventions that can prevent or control those conditions. For information on how to drive improvement on this measure, visit: www.cdc.gov/sixeighteen.  

States voluntarily report on PQI 01: Diabetes Short-Term Complications Admissions Rate (PQI01-AD) as part of the Core Set of Adult Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Adult Core Set measure specifications.

The included populations for Adult Core Set measures can vary by state. For example, some states report data on certain populations such as those covered under managed care but not those covered under fee-for-service (FFS). This variation in data can affect measure performance and comparisons between states.

PQI 01: Diabetes Short-Term Complications Admission Rate

Legend depicting visualization queues.

QI 01: Diabetes Short-Term Complications Admission Rate Bar Graph with Median of 16.4, and the categories and values. Described in table below.

State Population Rate per 100,000 beneficiary months
AL Medicaid 39.4
AR Medicaid; CHIP; Dual Eligibles 26.3
AZ Medicaid; Dual Eligibles 12.2
CA Medicaid 7.9
CT Medicaid; CHIP 9.7
DE Medicaid; Dual Eligibles 15.5
IA Medicaid 21.1
IL Medicaid; CHIP 13.3
LA Medicaid 15.6
MA Medicaid 9.8
MD Medicaid; CHIP 14.4
MI Medicaid 21.0
MN Medicaid; CHIP; Dual Eligibles 18.8
MO Medicaid; CHIP 23.3
NC Medicaid 23.2
NH Medicaid 21.1
NM Medicaid; Dual Eligibles 14.0
NY Medicaid 8.5
OK Medicaid; Dual Eligibles 30.2
OR Medicaid; Dual Eligibles 17.7
PA Medicaid 14.7
SC Medicaid; CHIP 23.3
TN Medicaid 13.2
TX Medicaid 17.1
VT Medicaid; CHIP 9.3
WA Medicaid; Dual Eligibles 15.6
WV Medicaid; Dual Eligibles 19.3
WY Medicaid; Dual Eligibles 21.4
States Reporting: 28 and Median Rate of Diabetes Short-term Complication Admission Rate per 100,000 Beneficiary Months: 16.4

Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports as of June 3, 2019 for the Adult Core Set Federal Fiscal Year (FFY) 2018 reporting cycle; see 2018 Child and Adult Health Care Quality Measures. PQI stands for prevention quality indicators, a set of measures maintained by the Agency for Healthcare Research and Quality (AHRQ). For more information about PQI 01: Diabetes Short-Term Complications Admissions Rate (PQI01-AD) visit Adult Health Care Quality Measures.

Notes:

The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: AK, CO, DC, FL, GA, HI, ID, IN, KS, KY, ME, MS, MT, ND, NE, NJ, NV, OH, RI, SD, UT, VA, and WI.

The Adult Core Set specifications include guidance for calculating this measure using the administrative method. Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans.

Unless otherwise specified:

  • States used Adult Core Set specifications, based on AHRQ 2018 specifications. 
  • Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments.
  • The measurement period for this measure was January 1, 2017 to December 31, 2017. AZ reported data for FFY 2016.
  • Rates displayed reflect state reporting for Medicaid enrollees ages 18 to 64 (26 states) or age 18 and older (2 states).

AHRQ = Agency for Healthcare Research and Quality; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CMO = Care Management Organization; CY = Calendar Year; ED = Emergency Department; EHR = Electronic Health Record; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner.

State-Specific Comments:

AL:          Rate includes FFS and PCCM populations. Rate excludes Medicare-Medicaid Dual Eligibles.

AZ:          Rate includes managed care population (6 MCOs), representing 78 percent of the population. Rate excludes FFS population, seriously mentally ill population, and state long-term care elderly, physically, or developmentally disabled population, representing 22 percent of the population. State conducted an internal validation of the data.

AR:          Rate includes FFS and PCCM populations. State used proprietary index hospitalization coding to determine hospital admissions, used HEDIS 2018 value sets (Maternity, Maternity Diagnosis, Pregnancy, and Pregnancy Diagnosis) to identify obstetric exclusions, and did not implement the hospital transfer, gender, quarter, year, or county exclusions. Rate was audited by the state's data contractor.

CA:          Rate includes FFS and managed care populations (26 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles.

CT:          Rate includes FFS population. Rate excludes Medicare-Medicaid Dual Eligibles.

DE:          Rate includes managed care population (1 MCO), representing 72 percent of the population. Rate excludes FFS population and enrollees in one MCO, representing 28 percent of the population.

IL:            Rate includes FFS, PCCM, and managed care populations (13 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. Rate was validated by the state's EQRO.

IA:           Rate includes FFS and managed care populations (3 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. State used the codes in the Pregnancy Value Set instead of Major Diagnostic Category (MDC) Code Admit = 14 (Pregnancy, Childbirth, and Puerperium). State used codes for transfers from an ambulatory surgical center and transfers from hospice in the Point of Origin field of claims instead of admission source codes for transfers from other hospitals or health facilities (including long-term care).

LA:          Rate includes FFS and managed care populations (5 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles.

MD:        Rate includes managed care population (8 MCOs), representing 83 percent of the population. Rate excludes FFS population, representing 17 percent of the population, and Medicare-Medicaid Dual Eligibles.

MA:        Rate includes PCCM and managed care populations (5 MCOs), representing 63 percent of the population. Rate excludes FFS population, representing 37 percent of the population, but most FFS beneficiaries would not be eligible for the measure, including beneficiaries who have other insurance (commercial or Medicare), reside in a long-term care institution, or receive limited or temporary Medicaid benefits.

MI:          Rate includes FFS and managed care populations (11 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles.

MN:        Rate includes FFS and managed care populations (8 MCOs).

MO:        Rate includes FFS and managed care populations (3 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. State identified transfers using claims data, defining a transfer as a discharge date with a subsequent admission on the same day or the next day. Transfers from a Skilled Nursing Facility or Intermediate Care Facility are identified using enrollment level of care start and stop dates. Numerator excludes admission dates that have an inpatient discharge from another facility or a facility level of care stop date on the day before or the day of the admission date.

NH:         Rate includes FFS and managed care populations (2 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles.

NM:        Rate includes managed care population (4 MCOs). MCO rates were audited by certified HEDIS auditors.

NY:          Rate includes FFS and managed care populations (73 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. State conducted an internal validation of the data.

NC:         Rate includes FFS and PCCM populations. Rate excludes Medicare-Medicaid Dual Eligibles.

OK:         Rate includes FFS and PCCM populations. Rate excludes home- and community-based services waiver enrollees.

OR:         Rate includes managed care population (16 CCOs), representing 82 percent of the population. Rate excludes FFS population, representing 18 percent of the population.

PA:          Rate includes managed care population (9 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. Age was determined as of discharge date. State provided MCOs with the following guidelines for calculating the measure: (1) include enrollees enrolled in the MCO at some point during the inpatient stay and continuous enrollment is not required; (2) the enrollment and disenrollment segment that overlaps with the stay and contiguous segments should be linked to show the longest continuous enrollment segment for the enrollee that overlaps with the inpatient stay; and (3) include paid and denied charges, and exclude events that were denied because the enrollee was not a member of the MCO during the stay. Data were submitted by MCOs and compiled by the state's EQRO.

SC:          Rate includes managed care population (5 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles.

TN:          Rate includes managed care population (4 MCOs) age 18 and older. Rate excludes Medicare-Medicaid Dual Eligibles.

TX:          Rate includes FFS and managed care populations (23 MCOs) age 18 and older. Rate excludes Medicare-Medicaid Dual Eligibles. Rate was validated by the state's EQRO.

VT:          Rate includes statewide 1115 waiver population enrolled in a public non-risk prepaid inpatient health plan population, representing the total Medicaid population. Rate excludes Medicare-Medicaid Dual Eligibles.

WA:        Rate includes FFS and managed care populations (5 MCOs).

WV:        Rate includes FFS and managed care populations (4 MCOs). Rate includes beneficiaries who were of appropriate age at any time during the measurement year. Rate does not exclude transfers from other hospitals, skilled nursing facilities, intermediate care facilities, and other health facilities.

WY:        Rate includes FFS population.