Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness.
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.
Blecker
Saul
S
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. sblecker@jhmi.edu
Zhang
Yiyi
Y
Ford
Daniel E
DE
Guallar
Eliseo
E
Dosreis
Susan
S
Steinwachs
Donald M
DM
Dixon
Lisa B
LB
Daumit
Gail L
GL
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