title: Heterogeneity in the quality of care for patients with multiple chronic conditions by psychiatric comorbidity.
abstract: BACKGROUND
  Little is known about the quality of care received by Medicaid enrollees with multiple chronic conditions (MCCs) and whether quality is different for those with mental illness.
  
  
  OBJECTIVE
  To examine cancer screening and single-disease quality of care measures in a Medicaid population with MCC and to compare quality measures among persons with MCC with varying medical comorbidities with and without depression or schizophrenia.
  
  
  METHODS
  Secondary data analysis using a unique data source combining Medicaid claims with other administrative datasets from North Carolina's mental health system.
  
  
  METHODS
  Medicaid-enrolled adults aged 18 and older with ≥2 of 8 chronic conditions (asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, seizure disorder, depression, or schizophrenia). Medicare/Medicaid dual enrollees were excluded due to incomplete data on their medical care utilization.
  
  
  METHODS
  We examined a number of quality measures, including cancer screening, disease-specific metrics, such as receipt of hemoglobin A1C tests for persons with diabetes, and receipt of psychosocial therapies for persons with depression or schizophrenia, and medication adherence.
  
  
  RESULTS
  Quality of care metrics was generally lower among those with depression or schizophrenia, and often higher among those with increasing levels of medical comorbidities. A number of exceptions to these trends were noted.
  
  
  CONCLUSIONS
  Cancer screening and single-disease quality measures may provide a benchmark for overall quality of care for persons with MCC; these measures were generally lower among persons with MCC and mental illness. Further research on quality measures that better reflect the complex care received by persons with MCC is essential.
authors.affiliation: *Department of Health Policy and Management, Gillings School of Global Public Health †Cecil G. Sheps Center for Health Services Research Center, University of North Carolina ‡Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy §Department of Health Policy and Management, Cecil G. Sheps Center for Health Services Research Center, University of North Carolina, Chapel Hill ∥Department of Informatics, Quality, and Evaluation, Community Care of North Carolina, Raleigh, NC.
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Domino
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Beadles
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Lichstein
authors.forename: Joel F
authors.initials: JF
authors.lastname: Farley
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Morrissey
authors.forename: Alan R
authors.initials: AR
authors.lastname: Ellis
authors.forename: C Annette
authors.initials: CA
authors.lastname: Dubard
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000453:epidemiology / Q000628:therapy; D012640:Seizures / Q000453:epidemiology / Q000628:therapy; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult