PMID- 22228248
OWN - NLM
STAT- MEDLINE
DCOM- 20120731
LR  - 20220321
IS  - 1537-1948 (Electronic)
IS  - 0025-7079 (Print)
IS  - 0025-7079 (Linking)
VI  - 50
IP  - 5
DP  - 2012 May
TI  - Mental comorbidity and quality of diabetes care under Medicaid: a 50-state 
      analysis.
PG  - 428-33
LID - 10.1097/MLR.0b013e318245a528 [doi]
AB  - 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.
FAU - Druss, Benjamin G
AU  - Druss BG
AD  - Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. 
      bdruss@emory.edu
FAU - Zhao, Liping
AU  - Zhao L
FAU - Cummings, Janet R
AU  - Cummings JR
FAU - Shim, Ruth S
AU  - Shim RS
FAU - Rust, George S
AU  - Rust GS
FAU - Marcus, Steven C
AU  - Marcus SC
LA  - eng
GR  - K24 MH075867/MH/NIMH NIH HHS/United States
GR  - K24 MH075867-01A1/MH/NIMH NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Med Care
JT  - Medical care
JID - 0230027
SB  - IM
MH  - Age Factors
MH  - Comorbidity
MH  - Diabetes Mellitus/*epidemiology/*therapy
MH  - Fee-for-Service Plans/statistics & numerical data
MH  - Female
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Medicaid/*statistics & numerical data
MH  - Mental Disorders/*epidemiology
MH  - Middle Aged
MH  - Quality Indicators, Health Care/statistics & numerical data
MH  - Quality of Health Care/*statistics & numerical data
MH  - Risk Factors
MH  - Sex Factors
MH  - Socioeconomic Factors
MH  - United States
PMC - PMC3360811
MID - NIHMS348638
EDAT- 2012/01/10 06:00
MHDA- 2012/08/01 06:00
PMCR- 2013/05/01
CRDT- 2012/01/10 06:00
PHST- 2012/01/10 06:00 [entrez]
PHST- 2012/01/10 06:00 [pubmed]
PHST- 2012/08/01 06:00 [medline]
PHST- 2013/05/01 00:00 [pmc-release]
AID - 10.1097/MLR.0b013e318245a528 [doi]
PST - ppublish
SO  - Med Care. 2012 May;50(5):428-33. doi: 10.1097/MLR.0b013e318245a528.