Mental Comorbidity and Chronic Illness in the National Medicaid System

医疗补助是美国最大的针对患有慢性病的贫困和残疾美国人的医疗保健计划，医疗补助受助人的精神障碍率是普通人群的两倍多。然而，很少有人知道心理comorbidity对医疗补助系统内的慢性疾病的护理质量的影响，这种关联如何在不同的心理诊断之间变化，或者如何由患者，提供者和系统层面的因素调节。最近发布的标准化50个州的医疗补助分析提取（MAX）文件首次使研究国家医疗补助系统内慢性病与精神疾病之间的关系成为可能。 我们提出了一项研究，使用50个州的医疗补助索赔数据，以研究精神共病对医疗补助接受者的护理质量的影响，其中三种慢性疾病-糖尿病，心脏病和哮喘。县一级的提供者和人口统计特征以及州一级的医疗补助政策参数将从其他数据源合并。 申请人提出1。研究不同的共病精神状况如何与三种慢性疾病的护理质量相关。分析将检查使用HEDIS指标的循证服务的使用不足和过度使用，如急诊室和住院服务用于门诊敏感条件所反映的。2.检查精神障碍和护理质量之间的关联如何受到患者，提供者，区域和医疗补助政策因素的调节，并通过使用门诊医疗服务进行介导。 这项研究将提供第一个全国性的描述精神疾病对医疗补助计划中的护理质量的影响，它如何在特定的精神状况下有所不同，以及它如何受到患者，提供者和系统层面的背景因素的影响。更好地了解医疗补助接受者中精神并发症的影响可以为州和联邦政策制定者、公共部门提供者和患者提供关键信息。它还将有助于更广泛地阐明贫困和弱势群体的共病状况与医疗质量之间的关系。项目叙述虽然医疗补助是一个关键的医疗保健计划，为贫困和残疾的美国人与慢性身体和精神疾病，鲜为人知的是，心理comorbidity的影响医疗补助系统内的一般医疗保健的质量。这项拟议中的研究将使用来自美国所有50个州的医疗补助索赔数据，以检查精神并发症对患有三种慢性疾病之一的医疗补助接受者的护理质量的影响-糖尿病，心脏病和哮喘。更好地了解医疗补助接受者中精神并发症的影响可以为州和联邦政策制定者、公共部门提供者和患者提供关键信息。

DESCRIPTION (provided by applicant): Medicaid is the nation's largest health care program for poor and disabled Americans with chronic illness, and rates of mental disorders are more than twice as high among Medicaid recipients as in the general population. However, little is known about the impact of mental comorbidity on quality of care for chronic conditions within the Medicaid system, how that association varies across different mental diagnoses, or how is moderated by patient, provider, and system-level factors. The recent release of standardized 50-state Medicaid Analytic Extract (MAX) Files makes it possible, for the first time, to study the relationship between chronic conditions and mental comorbidity within the national Medicaid system. We propose a study using 50-state Medicaid claims data to examine the implications of mental comorbidity for quality of care among Medicaid recipients with one of three chronic conditions --diabetes, heart disease, and asthma. County-level provider and demographic characteristics and state-level Medicaid policy parameters will be merged from other data sources. The application proposes to 1. Study how different comorbid mental conditions are associated with quality of care for the three chronic medical conditions. Analyses will examine both underuse of evidence- based services using HEDIS indicators and overuse, as reflected by use of Emergency Room and Inpatient services for ambulatory-sensitive conditions. 2. Examine how the association between mental disorders and quality of care is moderated by patient, provider, regional and Medicaid policy factors, and mediated by use of outpatient medical services. This study will provide the first national description of the impact of mental comorbidity on quality of care in the Medicaid program, how it differs across particular mental conditions, and how it is influenced by patient, provider, and system-level contextual factors. Better understanding the impact of mental comorbidity among Medicaid recipients can provide critical information for state and federal policymakers, public sector providers, and patients. It will also help to more broadly illuminate the relationship between comorbid conditions and quality of medical care in poor and vulnerable populations. Project Narrative Although Medicaid is a critical health care program for poor and disabled Americans with chronic physical and mental illnesses, little is known about the impact of mental comorbidity on quality of general medical care within the Medicaid system. The proposed study will use Medicaid claims data from all 50 US States to examine the impact of mental comorbidity on quality of care among Medicaid recipients with one of three chronic conditions--diabetes, heart disease, and asthma. Better understanding the impact of mental comorbidity among Medicaid recipients can provide critical information for state and federal policymakers, public sector providers, and patients.