马里兰州平价医疗法案医疗补助健康之家豁免对严重精神疾病患者心血管护理质量的影响。
Effects of Maryland's Affordable Care Act Medicaid Health Home Waiver on Quality of Cardiovascular Care Among People with Serious Mental Illness.
机构信息
Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
出版信息
J Gen Intern Med. 2020 Nov;35(11):3148-3158. doi: 10.1007/s11606-020-05690-9. Epub 2020 Mar 3.
BACKGROUND
Nineteen US states and D.C. have used the Affordable Care Act Medicaid health home waiver to create behavioral health home (BHH) programs for Medicaid beneficiaries with serious mental illness (SMI). BHH programs integrate physical healthcare management and coordination into specialty mental health programs. No studies have evaluated the effects of a BHH program created through the Affordable Care Act waiver on cardiovascular care quality among people with SMI.
OBJECTIVE
To study the effects of Maryland's Medicaid health home waiver BHH program, implemented October 1, 2013, on quality of cardiovascular care among individuals with SMI.
DESIGN
Retrospective cohort analysis using Maryland Medicaid administrative claims data from July 1, 2010, to September 30, 2016. We used marginal structural modeling with inverse probability of treatment weighting to account for censoring and potential time-dependent confounding.
PARTICIPANTS
Maryland Medicaid beneficiaries with diabetes or cardiovascular disease (CVD) participating in psychiatric rehabilitation programs, the setting in which BHHs were implemented. To qualify for psychiatric rehabilitation programs, individuals must have SMI. The analytic sample included BHH and non-BHH participants, N = 2605 with diabetes and N = 1899 with CVD.
MAIN MEASURES
Healthcare Effectiveness Data and Information Set (HEDIS) measures of cardiovascular care quality including annual receipt of diabetic eye and foot exams; HbA1c, diabetic nephropathy, and cholesterol testing; and statin therapy receipt and adherence among individuals with diabetes, as well as HEDIS measures of annual receipt of cholesterol testing and statin therapy and adherence among individuals with CVD.
KEY RESULTS
Relative to non-enrollment, enrollment in Maryland's BHH program was associated with increased likelihood of eye exam receipt among individuals with SMI and co-morbid diabetes, but no changes in other care quality measures.
CONCLUSIONS
Additional financing, infrastructure, and implementation supports may be needed to realize the full potential of Maryland's BHH to improve cardiovascular care for people with SMI.
背景
19 个州和哥伦比亚特区利用《平价医疗法案》医疗补助健康之家豁免权，为患有严重精神疾病（SMI）的医疗补助受益人创建行为健康之家（BHH）计划。BHH 计划将身体保健管理和协调纳入专业精神健康计划。目前尚无研究评估通过《平价医疗法案》豁免权创建的 BHH 计划对患有 SMI 的人群心血管保健质量的影响。
目的
研究马里兰州医疗补助健康之家豁免权 BHH 计划对患有 SMI 的个体心血管保健质量的影响。
设计
使用马里兰州医疗补助管理索赔数据进行回顾性队列分析，数据时间范围为 2010 年 7 月 1 日至 2016 年 9 月 30 日。我们使用边际结构模型和治疗逆概率加权来处理删失和潜在的时变混杂。
参与者
参与精神康复计划的马里兰州医疗补助受益人，BHH 实施的环境。要符合精神康复计划的条件，个人必须患有 SMI。分析样本包括 BHH 和非 BHH 参与者，糖尿病患者 n=2605，心血管疾病患者 n=1899。
主要测量指标
心血管保健质量的医疗保健效果数据和信息集（HEDIS）测量指标，包括糖尿病患者的年度眼部和足部检查、HbA1c、糖尿病肾病和胆固醇检测；以及他汀类药物治疗的接受和遵医嘱情况，以及心血管疾病患者的年度胆固醇检测、他汀类药物治疗和遵医嘱情况。
主要结果
与未参加相比，参加马里兰州 BHH 计划与 SMI 合并糖尿病患者接受眼部检查的可能性增加有关，但其他保健质量指标没有变化。
结论
可能需要额外的资金、基础设施和实施支持，以充分发挥马里兰州 BHH 的潜力，改善患有 SMI 的人群的心血管保健。
Zotero 插件