Benjamin G. Druss|Liping Zhao|Janet R. Cummings|Ruth Shim|George Rust|Steven C. Marcus
Mental Comorbidity and Quality of Diabetes Care Under Medicaid
Emory University|Emory University|Emory University|Morehouse School of Medicine|Morehouse School of Medicine|University of Pennsylvania
background patients comorbid medical mental conditions risk poor quality care anticipated expansion medicaid health reform particularly important develop national estimates magnitude correlates quality deficits related mental comorbidity among medicaid enrollees methods 657628 feeforservice medicaid enrollees diabetes 2003 2004 study compared healthcare effectiveness data information set hedis diabetes performance measures hemoglobin a1c eye examinations low density lipoproteins screening treatment nephropathy admissions ambulatory caresensitive conditions acscs persons without mental comorbidity nested hierarchical models included individual county statelevel measures results total 178 diabetic sample comorbid mental condition adjusted models presence mental condition associated 083 082085 odds obtaining 2 hedis indicators 132 129134 increase odds one acsc hospitalization among diabetes mental comorbidities living county shortage primary care physicians associated reduced performance hedis measures living state higher medicaid reimbursement fees department mental health expenses per client associated higher quality hedis measures lower better rates acsc hospitalizations conclusions among persons diabetes treated medicaid system mental comorbidity important risk factor underuse overuse medical care modifiable county statelevel factors may mitigate quality deficits