Diabetes treatment among VA patients with comorbid serious mental illness.
OBJECTIVE
Patients with serious mental illnesses, such as schizophrenia, bipolar disorder, and other psychoses, may be less likely to receive adequate care for chronic medical conditions than patients without serious mental illness. The quality and outcomes of diabetes care were compared in an observational study among patients with and without serious mental illness.


METHODS
National data were studied for 36,546 individuals receiving care within the U.S. Department of Veterans Affairs (VA) health care system. Widely used diabetes quality-of-care measures and intermediate outcomes were compared for patients with diabetes and serious mental illness and age-matched patients with diabetes who did not have a serious mental illness. Patients' use of health services was also examined.


RESULTS
During fiscal year 1998, patients with diabetes and serious mental illness were as likely as patients with diabetes alone to have their hemoglobin A1c, low-density lipoproteins (LDL), and cholesterol measured; both groups had comparable A1c, LDL, and cholesterol values. Patients with diabetes and serious mental illness had more outpatient visits, both primary care and specialty visits, and made more multiclinic visits, including visits to both primary care and mental health services on the same day.


CONCLUSIONS
In the VA, patients with diabetes and serious mental illness appear to receive diabetes care that is comparable with the care that other patients with diabetes receive, possibly because of increased levels of contact with the health system and the VA's integration of medical and mental health services.
Krein
Sarah L
SL
Center for Practice Management and Outcomes Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan 48113-0170, USA. skrein@umich.edu
Bingham
C Raymond
CR
McCarthy
John F
JF
Mitchinson
Allison
A
Payes
Jonathan
J
Valenstein
Marcia
M
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006787:Hospitals, Veterans; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008824:Michigan; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012559:Schizophrenia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D008077:Lipoproteins, LDL