Beyond health plans: Behavioral health disorders and quality of diabetes and asthma care for medicaid beneficiaries
Center for Health Policy and Research, Commonwealth Medicine, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA 01545, USA. Medical care
(Impact Factor: 3.23).
04/2009; 47(5):545-52. DOI: 10.1097/MLR.0b013e318190db45
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.
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.
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.
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.
Available from: Gail L Daumit
- "The remaining studies included Medicare beneficiaries (Druss et al., 2000, 2001; Rathore et al., 2008); a mix of Medicare and Medicaid beneficiaries (Leung et al, 2011); and other study populations sampled from outpatient clinics, inpatient facilities, or clinical trials (Bogart et al., 2006; R.J. Goldberg et al., 2007; R.W. Goldberg et al., 2007; Green et al., 2010; Himelhoch et al., 2007; Nasrallah et al., 2006; Weiss et al., 2006). Nine studies calculated quality metrics using administrative claims data (Banta et al., 2009; Blecker et al., 2010; Clark et al., 2009; Green et al., 2010; Kreyenbuhl et al., 2008; McGinty et al., 2012; Walkup et al., 2001, 2004) and eight studies obtained the data needed to calculate quality metrics through medical chart review (Bogart et al., 2006; Desai et al., 2002; R.J. Goldberg et al., 2007; R.W. Goldberg et al., 2007; Himelhoch et al., 2007; Kilbourne et al., 2008, 2011; Petersen et al., 2003; Rathore et al., 2008). Three studies used a combination of administrative claims and medical chart data (Druss et al., 2000, 2001; Rathore et al., 2008); and three used research-quality data collected in clinical trials or other studies (Frayne et al., 2005; Krein et al., 2006; Nasrallah et al., 2006). "
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ABSTRACT: Prior studies suggest variation in the quality of medical care for somatic conditions such as cardiovascular disease and diabetes provided to persons with SMI, but to date no comprehensive review of the literature has been conducted. The goals of this review were to summarize the prior research on quality of medical care for the United States population with SMI; identify potential sources of variation in quality of care; and identify priorities for future research.
Peer-reviewed studies were identified by searching four major research databases and subsequent reference searches of retrieved articles. All studies assessing quality of care for cardiovascular disease, diabetes, dyslipidemia, and HIV/AIDs among persons with schizophrenia and bipolar disorder published between January 2000 and December 2013 were included. Quality indicators and information about the study population and setting were abstracted by two trained reviewers.
Quality of medical care in the population with SMI varied by study population, time period, and setting. Rates of guideline-concordant care tended to be higher among veterans and lower among Medicaid beneficiaries. In many study samples with SMI, rates of guideline adherence were considerably lower than estimated rates for the overall US population.
Future research should identify and address modifiable provider, insurer, and delivery system factors that contribute to poor quality of medical care among persons with SMI and examine whether adherence to clinical guidelines leads to improved health and disability outcomes in this vulnerable group.
Copyright © 2015 Elsevier B.V. All rights reserved.
Available from: Jordan W Tompkins
- "Current literature suggests that large administrative datasets lack precision and detail [14,22-25], and as the clinical practice world progresses toward electronic medical systems and chronic disease registries, there is a clear need to validate a methodology for identifying individuals with chronic diseases and specifically, diabetes. Our results support the ODD algorithm for diabetes diagnosis in administrative data, and suggest an EMR standard for diagnosis of disease in the DELPHI database using Definition 1.c. "
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ABSTRACT: Electronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medical record definition for diabetes.
We constructed a retrospective cohort using health administrative data from the Institute for Clinical Evaluative Sciences Ontario Diabetes Database linked with electronic medical records from the Deliver Primary Healthcare Information Project using data from 1 April 2006-31 March 2008 (N = 19,443). We systematically examined eight definitions for diabetes diagnosis, both established and proposed.
The definition that identified the highest number of patients with diabetes (N = 2,180) while limiting to those with the highest probability of having diabetes was: individuals with ≥2 abnormal plasma glucose tests, or diabetes on the problem list, or insulin prescription, or ≥2 oral anti-diabetic agents, or HbA1c ≥6.5%. Compared to the Ontario Diabetes Database, this definition identified 13% more patients while maintaining good sensitivity (75%) and specificity (98%).
This study establishes the feasibility of developing an electronic medical record standard definition of diabetes and validates an algorithm for use in this context. While the algorithm may need to be tailored to fit available data in different electronic medical records, it contributes to the establishment of validated disease registries with the goal of enhancing research, and enabling quality improvement in clinical care and patient self-management.
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ABSTRACT: To evaluate three aspects of diabetes care (foot checks, eye examinations, and hemoglobin A 1 C checks by a physician) among California adults with Type 2 diabetes and serious psychological distress (SPD).
Data were from the population-based 2005 California Health Interview Survey. Estimates were that in 2005, 1,516,171 Californians (5.75% of all adults) had a physician-given diabetes diagnosis, and of those, 108,621 (7.16%) had co-morbid SPD.
Among Californians with Type 2 diabetes, SPD was associated with fewer physician foot checks (odds ratio = 0.56, 95% Confidence Interval = 0.32 to 0.97) but not with fewer eye examinations or hemoglobin A 1 C checks.
The findings highlight a specific area--foot complication evaluation and prevention--for improving the quality of diabetes care among adult Californians with Type 2 diabetes and SPD.
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