Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness☆
Received 3 December 2009; accepted 3 February 2010. published online 17 March 2010.
Abstract
Objective
To examine the association between severe mental illness (SMI) and quality of care in heart failure.
Methods
We conducted a cohort study between 2001 and 2004 of disabled Maryland Medicaid participants with heart failure. Quality measures and clinical outcomes were compared for individuals with and without SMI.
Results
Of 1801 individuals identified with heart failure, 341 had comorbid SMI. SMI was not associated with differences in quality measures, including left ventricular assessment [adjusted relative risk (aRR) 0.99; 95% CI 0.91–1.07], utilization of angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) (aRR 1.04; 95% CI 0.92–1.17), or beta-blocker use (aRR 1.13; 95% CI 0.99–1.29). During the study period, 52.2% of individuals in the cohort filled a prescription for an ACE inhibitor or ARB and 45.5% filled a beta-blocker prescription. Individuals with and without SMI had similar rates of clinical outcomes, including hospitalizations, readmissions, and mortality. Both medication interventions were associated with improved mortality.
Conclusions
In this sample of disabled Medicaid recipients with heart failure, persons with SMI received similar quality of care as those without SMI. Both groups had low rates of beneficial medical treatments. Quality improvement programs should consider how best to target these vulnerable populations.
aDivision of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
bWelch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
cDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
dDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
eDepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
fDepartment of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
gDepartment of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Corresponding author. Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA, Tel.: +1 410 614 6464; fax: +1 410 955 0476.
☆ Funding Sources: Dr. Blecker was supported by National Heart, Lung, and Blood Institute grant 5T32HL007024. Dr. Daumit was supported by National Institute of Mental Health grant R01-MH074070.
ABSTRACT