title: Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness.
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.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. sblecker@jhmi.edu
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.forename: Yiyi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.forename: Susan
authors.initials: S
authors.lastname: Dosreis
authors.forename: Donald M
authors.initials: DM
authors.lastname: Steinwachs
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Dixon
authors.forename: Gail L
authors.initials: GL
authors.lastname: Daumit
mesh_terms: D000368:Aged; D015331:Cohort Studies; D006233:Persons with Disabilities; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008396:Maryland; D008484:Medicaid; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D012720:Severity of Illness Index; D014481:United States