With an estimated 30.2 million diagnosed and undiagnosed cases among adults (and another 84 million at risk), diabetes mellitus is one of the most prevalent chronic conditions and a leading cause of mortality in the US. Diabetes self-management education and training (DSME/T) is a recognized standard of care and provides patients with the requisite knowledge and skills to properly manage the condition, improve long-term health outcomes, and reduce health care spending. Yet, only (58%) of adults with diabetes report ever receiving formal DSME/T. Health insurance coverage that does not include benefits for DSME/T effectively imposes barriers to access for patients with limited financial resources. Many states have adopted legislation that requires public and/or private insurers to provide benefits for DSME/T; however, these requirements vary by state. It is unclear if these policies effectively improve access to DSME/T services. The objective of this proposal is to rigorously assess the impact of state-mandated health insurance benefits and reimbursement provisions on access to DSME/T among vulnerable, low-income patients with diabetes.
Aim 1, quantify the change in the supply of DSME/T programs and certified providers (potential access) before and after the adoption of state-mandated benefits, tests the hypothesis that enactment of DSME/T insurance requirements is associated with an increase in the number of accredited DSME/T programs and certified providers within a state.
This aim merges two novel datasets to provide a census of accredited DSME/T programs and certified providers and detail provisions of state benefit mandates over a period of ten years for 30 US states.
Aim 2, quantify the impact of state-mandated insurance benefits on utilization (realized access) of DSME/T, tests the hypothesis that Medicaid insurance requirements increases utilization of DSME/T among Medicaid patients with diabetes.
This aim will utilize an 9-year panel from twenty states included in the Medical Expenditure Panel Survey (MEPS) from 2008 to 2016.
Aim 3, examine the association between patients? evaluated need for DSME/T and providers? referral orders for DSME/T (equitable access), will utilize electronic health record data (2010-2017) from a safety net population to test the hypothesis that patients? ?evaluated need? will increase the likelihood of receiving a DSME/T referral during a provider encounter. The proposed study is significant because it rigorously measures the impact of decades of state policies to address a ?priority condition? in the US. This study is innovative because it extends the evidence-base for diabetes care services through the use of novel data sources and a more sophisticated and policy-relevant measurement approach. Lastly, the proposed study effectively targets a high priority research area as defined by AHRQ: increasing the accessibility of healthcare.
Increasing access to diabetes self-management education and training (DSME/T) is relevant to public health because it is a recognized standard of care that is associated with improved health outcomes and reduced costs for one of the most prevalent chronic conditions in the US. By measuring the impact of state-mandated insurance benefits on potential, realized, and equitable access to DSME/T among patients with diabetes, this study effectively supports AHRQ?s goal to improve the accessibility of healthcare.
