title: Where You Live Matters: Quality and Racial/Ethnic Disparities in Schizophrenia Care in Four State Medicaid Programs.
abstract: OBJECTIVE
  To determine whether (a) quality in schizophrenia care varies by race/ethnicity and over time and (b) these patterns differ across counties within states.
  
  
  METHODS
  Medicaid claims data from California, Florida, New York, and North Carolina during 2002-2008.
  
  
  METHODS
  We studied black, Latino, and white Medicaid beneficiaries with schizophrenia. Hierarchical regression models, by state, quantified person and county effects of race/ethnicity and year on a composite quality measure, adjusting for person-level characteristics.
  
  
  RESULTS
  Overall, our cohort included 164,014 person-years (41-61 percent non-whites), corresponding to 98,400 beneficiaries. Relative to whites, quality was lower for blacks in every state and also lower for Latinos except in North Carolina. Temporal improvements were observed in California and North Carolina only. Within each state, counties differed in quality and disparities. Between-county variation in the black disparity was larger than between-county variation in the Latino disparity in California, and smaller in North Carolina; Latino disparities did not vary by county in Florida. In every state, counties differed in annual changes in quality; by 2008, no county had narrowed the initial disparities.
  
  
  CONCLUSIONS
  For Medicaid beneficiaries living in the same state, quality and disparities in schizophrenia care are influenced by county of residence for reasons beyond patients' characteristics.
authors.affiliation: RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA.
authors.forename: Marcela
authors.initials: M
authors.lastname: Horvitz-Lennon
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Rita
authors.initials: R
authors.lastname: Volya
authors.affiliation: Kaiser Family Foundation, Washington, DC.
authors.forename: Rachel
authors.initials: R
authors.lastname: Garfield
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.affiliation: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Judith R
authors.initials: JR
authors.lastname: Lave
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA.|Department of Biostatistics, Harvard School of Public Health, Boston, MA.
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000208:ethnology / Q000628:therapy*; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data
keywords: Medicaid; geographic variation; quality of care; racial/ethnic disparities; schizophrenia