Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA 01545, USA.
Am J Manag Care. 2011 Feb;17(2):144-50.
To investigate whether Medicare and/or Medicaid beneficiaries with behavioral health disorders (BHDs) receive lower quality diabetes care.
Retrospective observational study using merged Medicare and Medicaid claims data from Massachusetts in calendar years 2004 and 2005.
The study included beneficiaries who had type 2 diabetes, stayed at nursing homes for fewer than 90 days, and were enrolled in Medicare and/or Medicaid for at least 10 months during the study period. We used Current Procedural Terminology (CPT) codes to identify the receipt of 4 measures of diabetes care quality (ie, glycated hemoglobin tests, low-density lipoprotein cholesterol tests, nephropathy tests, eye examinations). The rates of adherence (defined by proportions of beneficiaries receiving appropriate services for each measure) were compared across different types of BHDs as identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses. Multivariate logistic regression was used to compare the odds of adherence among beneficiaries who had BHDs with the odds among beneficiaries who had no BHDs, while adjusting for case mix.
A total of 106,174 individuals met inclusion criteria. Results from adjusted analysis showed a mixed picture of the relationships between BHDs and adherence to quality measures. While substance use disorders were associated with lower adherence to quality measures, beneficiaries with diagnoses of schizophrenia or paranoid states had higher odds for adherence to quality measures.
Individuals with diabetes and substance use disorders receive lower quality diabetes care. Further studies to examine the factors associated with this disparity are needed.
调查患有行为健康障碍（BHD）的医疗保险和/或医疗补助受益人是否接受的糖尿病护理质量较低。
使用马萨诸塞州 2004 年和 2005 年医疗保险和医疗补助合并索赔数据进行回顾性观察研究。
该研究包括患有 2 型糖尿病、在养老院居住少于 90 天且在研究期间至少有 10 个月参加医疗保险和/或医疗补助的受益人。我们使用当前程序术语（CPT）代码来确定 4 种糖尿病护理质量指标（即糖化血红蛋白测试、低密度脂蛋白胆固醇测试、肾病测试、眼科检查）的接受情况。根据国际疾病分类，第九修订版，临床修正诊断确定的不同类型 BHD 来比较每种指标的遵守率（通过接受适当服务的受益人的比例来定义）。使用多变量逻辑回归比较患有 BHD 的受益人与没有 BHD 的受益人的遵守率的几率，同时调整病例组合。
共有 106174 人符合纳入标准。调整分析的结果显示 BHD 与遵守质量措施之间的关系是混杂的。虽然物质使用障碍与遵守质量措施的可能性降低有关，但诊断为精神分裂症或偏执状态的受益人的遵守质量措施的几率更高。
患有糖尿病和物质使用障碍的个体接受的糖尿病护理质量较低。需要进一步研究以检查与这种差异相关的因素。
