Lawthers A, Hashemi L, Clark R; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 3100.
University of Massachusetts Medical School, Center for Health Policy and Research, 222 Maple Ave, Shrewsbury, MA 01545 Tel. 508-856-1531 Fax
RESEARCH OBJECTIVE: To assess the quality of treatment, monitoring and preventive care for chronic physical illness among Medicaid members with mental health or substance abuse disorders enrolled in a primary care case management program. STUDY DESIGN: Using Medicaid claims data, members were grouped into three behavioral health (BH) categories based on diagnoses: severe mental illness (schizophrenia, other psychotic disorders, bipolar disorder or major depression), other behavioral health disorders or no behavioral health diagnoses. Drug or alcohol disorders were identified separately within the first two groups. Individuals with asthma, chronic obstructive pulmonary disease (COPD), hypertension, ischemic heart disease or diabetes mellitus were identified within each of the three BH categories. Individuals could be assigned to multiple physical disease groups but to only one behavioral health category.Quality of care indicators for treatment, monitoring or prevention were identified for each physical disease group based on HEDIS measures and other evidence-based measurement initiatives. Medicaid claims analyses determined whether each indicator was met and summed across all indicators to create a quality score for each individual. Scores were then averaged to produce summary quality of care measures each physical condition. POPULATION STUDIED: Study population included 120,933 Medicaid members between the ages of 18 and 64 who were enrolled in Massachusetts Primary Care Clinician (PCC) Plan for >320 days in fiscal year 2003 (July, 2002 through June, 2003.) Approximately one-fifth (21.8%) had a severe mental disorder (SMI), one fifth (20.3%) had another type of behavioral health diagnosis (Other BH). The remainder had no claims with a mental health or substance abuse diagnosis (Non-BH). One quarter of the population had at least one of the five identified physical conditions. PRINCIPAL FINDINGS: Rates of asthma, diabetes and hypertension were highest in the SMI group. The Other BH group had slightly higher rates of heart disease and COPD. Quality of care scores ranged from 59% for heart disease to 66% for asthma. Quality differences across the three behavioral health groups were small, ranging from one percentage point for hypertension to four points for diabetes. Contrary to expectations, individuals with SMI had the highest quality scores for each physical condition. Members of the Other-BH group consistently had the lowest scores. Drug and alcohol disorders were strongly associated with lower quality of care. Members with a substance abuse disorder had scores from six to eight percentage points lower than others. Use of preventive care by those without a chronic physical condition suffered the most, with substance abusers averaging 12% lower scores than others. CONCLUSIONS: Substance abuse is consistently associated with lower quality of care for physical illness. Within this particular managed care program, individuals with SMI received physical health care similar to, or better than, that provided to other groups. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: These data suggest that interventions targeting individuals with alcohol or drug abuse diagnoses may improve the quality of physical health care.
Publication Types:
Keywords:
- Asthma
- Chronic Disease
- Managed Care Programs
- Massachusetts
- Medicaid
- Mental Disorders
- Population Groups
- Primary Health Care
- Psychotic Disorders
- Pulmonary Disease, Chronic Obstructive
- Substance-Related Disorders
- economics
- methods
- hsrmtgs
UI: 103622563
From Meeting Abstracts