Heterogeneity in the quality of care for patients with multiple chronic conditions by psychiatric comorbidity

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. Objectives: 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. Research Design: Secondary data analysis using a unique data source combining Medicaid claims with other administrative datasets from North Carolina's mental health system. Subjects: 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. Measures: 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.