PMID- 19319000
OWN - NLM
STAT- MEDLINE
DCOM- 20090514
LR  - 20090427
IS  - 1537-1948 (Electronic)
IS  - 0025-7079 (Linking)
VI  - 47
IP  - 5
DP  - 2009 May
TI  - Beyond health plans: behavioral health disorders and quality of diabetes and 
      asthma care for Medicaid beneficiaries.
PG  - 545-52
LID - 10.1097/MLR.0b013e318190db45 [doi]
AB  - BACKGROUND: Most health insurance plans monitor ambulatory care quality using the 
      Healthcare Effectiveness Data and Information Set (HEDIS), publicly reporting 
      results at the plan level. Plan-level comparisons obscure the influence of 
      patients served or settings where care is delivered. Mental illness, substance 
      abuse, and other physical comorbidities, particularly prevalent among Medicaid 
      beneficiaries, can impact adherence to recommended care. We analyzed 
      individual-level HEDIS measures for diabetes and asthma from 5 Medicaid managed 
      care plans to understand how these factors contribute to quality. METHODS: We 
      used claims and medical records to study HEDIS measures for persistent asthma (n 
      = 9103) and diabetes (n = 1790) among beneficiaries enrolled in Massachusetts' 
      Medicaid program during 2004 and 2005. Logistic regression models included 
      patient-level demographic and health factors, provider type, region, and managed 
      care plan. RESULTS: Alcohol and drug use disorders and emergency department use 
      were associated with lower quality care for most measures. Glycemic control was 
      better for patients with diabetes and severe mental illness. Patients with higher 
      illness burden and with more frequent ambulatory visits received higher quality 
      care for both conditions. Younger adults received recommended care less often 
      than older adults. Quality varied across plans. CONCLUSIONS: Additional efforts 
      to improve quality of care for asthma and diabetes for Medicaid beneficiaries are 
      needed for individuals with substance use disorders and young adults. Although 
      evidence of higher quality for patients with multiple conditions is encouraging, 
      improving quality for comparatively healthier individuals might also produce 
      significant long-term benefits.
FAU - Clark, Robin E
AU  - Clark RE
AD  - Center for Health Policy and Research, Commonwealth Medicine, University of 
      Massachusetts Medical School, 333 South Street, Shrewsbury, MA 01545, USA. 
      robin.clark@umassmed.edu
FAU - Weir, Sharada
AU  - Weir S
FAU - Ouellette, Rebecca A
AU  - Ouellette RA
FAU - Zhang, Jianying
AU  - Zhang J
FAU - Baxter, Jeffrey D
AU  - Baxter JD
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Med Care
JT  - Medical care
JID - 0230027
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Asthma/*therapy
MH  - Child
MH  - Child, Preschool
MH  - Diabetes Mellitus/*therapy
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Managed Care Programs/standards
MH  - Massachusetts
MH  - Medicaid
MH  - Middle Aged
MH  - *Quality of Health Care
MH  - *Substance-Related Disorders
MH  - United States
MH  - Young Adult
EDAT- 2009/03/26 09:00
MHDA- 2009/05/15 09:00
CRDT- 2009/03/26 09:00
PHST- 2009/03/26 09:00 [entrez]
PHST- 2009/03/26 09:00 [pubmed]
PHST- 2009/05/15 09:00 [medline]
AID - 10.1097/MLR.0b013e318190db45 [doi]
PST - ppublish
SO  - Med Care. 2009 May;47(5):545-52. doi: 10.1097/MLR.0b013e318190db45.