Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness

Blecker, Saul; Zhang, Yiyi; Ford, Daniel E.; Guallar, Eliseo; dosReis, Susan; Steinwachs, Donald M.; Dixon, Lisa B.; Daumit, Gail L.

doi:10.1016/j.genhosppsych.2010.02.002

« Previous Next »General Hospital Psychiatry
Volume 32, Issue 3 , Pages 255-261, May 2010

Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness☆

Saul Blecker, M.D.
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, 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.
Yiyi Zhang, M.H.S.
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Daniel E. Ford, M.D., M.P.H.
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Eliseo Guallar, M.D., Dr.Ph.
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Susan dosReis, Ph.D.
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
Donald M. Steinwachs, Ph.D.
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
Lisa B. Dixon, M.D., M.P.H.
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Gail L. Daumit, M.D., M.H.S.
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA

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.

Keywords: Mental disorders, Heart failure, Quality of healthcare, Outcome assessment

To access this article, please choose from the options below

☆ 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.

PII: S0163-8343(10)00018-6

doi:10.1016/j.genhosppsych.2010.02.002

« Previous Next »General Hospital Psychiatry
Volume 32, Issue 3 , Pages 255-261, May 2010

Access this article on SciVerse ScienceDirect