Mental Comorbidity and Quality of Diabetes Care Under Medicaid

BACKGROUND: Patients with comorbid medical and mental conditions are at risk for poor quality of care. With the anticipated expansion of Medicaid under health reform, it is particularly important to develop national estimates of the magnitude and correlates of quality deficits related to mental comorbidity among Medicaid enrollees. METHODS: For all 657,628 fee-for-service Medicaid enrollees with diabetes during 2003 to 2004, the study compared Healthcare Effectiveness Data and Information Set (HEDIS) diabetes performance measures (hemoglobin A1C, eye examinations, low density lipoproteins screening, and treatment for nephropathy) and admissions for ambulatory care-sensitive conditions (ACSCs) between persons with and without mental comorbidity. Nested hierarchical models included individual, county, and state-level measures. RESULTS: A total of 17.8% of the diabetic sample had a comorbid mental condition. In adjusted models, presence of a mental condition was associated with a 0.83 (0.82-0.85) odds of obtaining 2 or more HEDIS indicators, and a 1.32 (1.29-1.34) increase in odds of one or more ACSC hospitalization. Among those with diabetes and mental comorbidities, living in a county with a shortage of primary care physicians was associated with reduced performance on HEDIS measures; living in a state with higher Medicaid reimbursement fees and department of mental health expenses per client were associated both with higher quality on HEDIS measures and lower (better) rates of ACSC hospitalizations. CONCLUSIONS: Among persons with diabetes treated in the Medicaid system, mental comorbidity is an important risk factor for both underuse and overuse of medical care. Modifiable county and state-level factors may mitigate these quality deficits

Comorbidity · Diabetes mellitus · Environmental health · Family medicine · Health care · Logistic regression · Medicaid · Mental health · National Comorbidity Survey · Odds · Odds ratio · Psychiatry · Reimbursement · Chronic Disease Management Strategies · Diabetes Management and Education · Emergency Medicine · Internal Medicine · Medicine · Primary Care and Health Outcomes · Gerontology

• Improving quality of life assessments for high-need adult Medicaid service users with mental health conditions

  Open Access•Adrienne Nevola, Michael E Morris et al.•Quality of Life Research•2020

  Incluir item

• A Qualitative Study on Primary Care Integration into an Asian Immigrant-specific Behavioural Health Setting in the United States

  Open Access•Kris Pui Kwan, Anne Saw•International Journal of…•2018

  Incluir item

• “They Treat you a Different Way

  Open Access•Anna C Martínez-Hume, Anna C Martinez‐hume et al.•Culture Medicine and Psychiatry•2017

  Incluir item

• Discontinuity of Medicaid Coverage

  Xu Ji, Adam S Wilk et al.•Medical Care•2017

  Incluir item

• Not Alone Anymore”

  Victoria Mayer, Victoria L Mayer et al.•Medical Care•2020

  Incluir item

• The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness

  Margaret E Burns, Marguerite E Burns et al.•Medical Care•2016

  Incluir item

• Serious Mental Illness and Risk for Hospitalizations and Rehospitalizations for Ambulatory Care-sensitive Conditions in Denmark

  Dimitry S Davydow, Anette R Ribe et al.•Medical Care•2016

  Incluir item

• Do Race, Ethnicity, and Psychiatric Diagnoses Matter in the Prevalence of Multiple Chronic Medical Conditions

  L J Cabassa, Jennifer Humensky et al.•Medical Care•2013

  Incluir item

• The Impact of Integrated Case Management on Health Services Use and Spending Among Nonelderly Adult Medicaid Enrollees

  Lindsay M Sabik, Gloria J Bazzoli et al.•Medical Care•2016

  Incluir item

• Contextual Factors in the Health of People With Serious Mental Illness

  Open Access•L J Cabassa, Elizabeth Siantz et al.•Qualitative Health Research•2014

  Incluir item

• Preventable Hospitalizations and Access to Health Care

  Andrew B Bindman•JAMA•1995

  Incluir item

• Socioeconomic Status and Psychiatric Disorders

  Open Access•B P Dohrenwend, Itzhak Levav et al.•Science•1992

  Incluir item

• Rates of Avoidable Hospitalization by Insurance Status in Massachusetts and Maryland

  Joel S Weissman•JAMA•1992

  Incluir item

• Association of Health Plans' Healthcare Effectiveness Data and Information Set (Hedis) Performance With Outcomes of Enrollees With Diabetes

  Jeffrey S Harman, Sarah Hudson Scholle et al.•Medical Care•2010

  Incluir item

• Beyond Health Plans

  Robin E Clark, Sharada Weir et al.•Medical Care•2009

  Incluir item

• Emergency Department Visits for Ambulatory Care Sensitive Conditions

  Ady Oster, Andrew B Bindman•Medical Care•2003

  Incluir item

• Comorbidity Measures for Use with Administrative Data

  Anne Elixhauser, Claudia Steiner et al.•Medical Care•1998

  Incluir item

• Comparison of the Elixhauser and Charlson/Deyo Methods of Comorbidity Measurement in Administrative Data

  Danielle A Southern, Hude Quan et al.•Medical Care•2004

  Incluir item

• Studying Prescription Drug Use and Outcomes With Medicaid Claims Data

  Stephen Crystal, Ayse Akincigil et al.•Medical Care•2007

  Incluir item

• Ambulatory Care Sensitive Hospitalizations and Emergency Visits

  Marilyn Falik, Jacob Needleman et al.•Medical Care•2001

  Incluir item

• Impact of Sociodemographic Case Mix on the Hedis Measures of Health Plan Quality

  Alan M Zaslavsky, John N Hochheimer et al.•Medical Care•2000

  Incluir item

• Identifying and Addressing the Social Determinants of the Incidence and Successful Management of Type 2 Diabetes Mellitus in Canada

  Open Access•Vanessa Ling Yu, Dana Raphael et al.•Canadian Journal of Public Health•2004

  Incluir item