PQI 01:Diabetes Short-Term Complications Admission Rate

About This Measure

This measure reports state performance on inpatient hospital admissions for short-term diabetes complications (diabetic ketoacidosis, hyperosmolarity, or coma). The measure is the rate of admissions per 100,000 beneficiary-months for adults age 18 and older. Lower rates are better.

The data presented below are taken from the Adult Core Set for Federal Fiscal Year (FFY) 2016. Reporting is currently voluntary and reporting methods can vary by state.  For example, some states have access to different data on populations covered under fee-for-service as compared to populations covered under managed care. This variation in data availability can impact measure performance. Readers should review the detailed measure notes located after the graph to better understand states’ reported rates.

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

CMS publicly reported states’ performance on this measure for the first time for FFY 2016.

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

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Stem plot with a median of 19 per 100,000 enrollee-months and the states and values:

State Rate per 100,000 enrollee-months
Alabama 41
Arkansas 28
Colorado 19
Connecticut 15
Delaware 18
Georgia 32
Illinois 14
Iowa 47
Louisiana 15
Michigan 21
Minnesota 19
Montana 18
New Hampshire 15
New York 12
North Carolina 43
Ohio 25
Oklahoma 28
Oregon 13
Pennsylvania 23
Tennessee 17
Texas 26
Vermont 10
Washington 15
West Virginia 37
Wyoming 18

Source: Mathematica analysis of MACPro reports for the Adult Core Set FFY 2016 reporting cycle; see 2016 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.

Notes:

The following states did not report data to CMS for this measure: AK, AZ, CA, DC, FL, HI, ID, IN, KS, KY, MA, MD, ME, MO, MS, ND, NE, NJ, NM, NV, RI, SC, SD, UT, VA, and WI.

Measure Specific Tables (MSTs) available on Medicaid.gov provide important context for understanding state performance on each measure. MSTs include information about variation in included populations, methods, and data sources used to calculate the measure, as well as deviations from Core Set measure specifications.

Unless otherwise specified:

  • States used Adult Core Set specifications, based on AHRQ 2016 specifications. 
  • The measurement period for this measure was January 1, 2015 to December 31, 2015.
  • Rates displayed reflect state reporting for Medicaid beneficiaries ages 18 to 64 or age 18 and older.

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 and/or data submitted by managed care plans, including behavioral health plans.

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 below.

State-Specific Comments:

AL: Rate includes FFS and PCCM populations who are eligible for full Medicaid benefits. Rate excludes Medicare-Medicaid Dual Eligibles.

AR: Rate includes PCCM population, representing 99 percent of the population. Rate excludes Medicare-Medicaid Dual Eligibles. Rate was calculated using administrative claims data, rather than hospital discharge data.

CO: Rate includes FFS and PCCM populations. Rate excludes managed care population, representing 7 percent of the population. Rate was calculated by the state's EQRO.

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

DE: Rate includes managed care population (2 MCOs), representing 85 percent of the population. Rate excludes FFS population, representing 15 percent of the population.

GA: Rate includes FFS and managed care populations (4 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles and Planning for Healthy Babies (P4HB) demonstration members per CMS Special Terms and Conditions.

IL: Rate includes FFS, PCCM, and managed care populations (13 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. Rate includes paid claims only. State used the end of the calendar year as the anchor date for calculating age, rather than admission date or date of service. Member months are calculated as members' total enrolled days divided by 30.4 days. Transfers from a hospital, skilled nursing facility, intermediate care facility, or another health care facility were identified and excluded. Rate was audited by the state's EQRO.

IA: Rate includes FFS, PCCM, and managed care populations (1 MCO). Rate excludes Medicare-Medicaid Dual Eligibles. State did not use Major Diagnostic Category (MDC) Code Admit = 14, and instead used the ICD9/10 diagnosis codes in the Pregnancy Value Set. State did not use admission source codes for transfers from other hospitals or health facilities (including long-term care), but instead used codes for transfers from an ambulatory surgical center and transfers from hospice in the Point of Origin field of claims.

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

MI: Rate includes FFS and managed care populations (13 MCOs). Rate excludes beneficiaries who had other insurance (commercial or Medicare).

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

MT: Rate includes FFS population.

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

NY: Rate includes FFS and managed care populations (65 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles.

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

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

OK: Rate includes FFS and PCCM populations. Rate excludes home- and community-based services waiver enrollees, representing 9 percent of the adult Medicaid population. State used a continuous enrollment criterion of any number of allowable gaps up to 45 days.

OR: Rate includes managed care population (16 CCOs), representing 77 percent of the population. Rate excludes the FFS population, representing 23 percent of the population.

PA: Rate includes managed care population (9 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. Age was determined as of date of discharge. State provided MCOs with the following guidelines for calculating the measure: (1) to include enrollees enrolled in the MCO at some point during the inpatient stay and that continuous enrollment is not required; (2) to provide the enrollment and disenrollment segment that overlaps with the stay and that contiguous segments should be linked to show the longest continuous enrollment segment for the enrollee that overlaps with the inpatient stay; and (3) to 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.

TN: Rate includes managed care population (4 MCOs). Rate excludes Medicare-Medicaid Dual Eligibles. Rate was calculated by the state's EQRO.

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

VT: Rate includes FFS population. Rate excludes Medicare-Medicaid Dual Eligibles. Rate was calculated by the state's EQRO and data analytics contractor.

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

WV: Rate includes FFS and managed care populations (4 MCOs). Rate includes patients who were of appropriate age at any time during the measurement year and only includes paid claims. Transfers are not excluded from the measure. Rate was calculated by the state's EQRO and data analytics contractor.

WY: Rate includes FFS population.