Mental Comorbidity and Chronic Illness in the National Medicaid System

描述（由申请人提供）：医疗补助计划是美国最大的针对患有慢性疾病的贫困和残疾美国人的医疗保健计划，在医疗补助计划接受者中，精神障碍的发病率是普通人群的两倍多。然而，在医疗补助系统中，精神共病对慢性病护理质量的影响，这种关联在不同的精神诊断中是如何变化的，或者是如何被患者、提供者和系统层面的因素所调节的，我们所知甚少。最近发布的标准化的50个州的医疗补助分析摘录（MAX）文件，首次使得在国家医疗补助系统中研究慢性疾病和精神共病之间的关系成为可能。

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.