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Disparities in Diabetes Care
Impact of Mental Illness
Susan M. Frayne, MD, MPH;
Jewell H. Halanych, MD, MSc;
Donald R. Miller, ScD;
Fei Wang, PhD;
Hai Lin, MD, MPH;
Leonard Pogach, MD, MBA;
Erica J. Sharkansky, PhD;
Terence M. Keane, PhD;
Katherine M. Skinner, PhD ;
Craig S. Rosen, PhD;
Dan R. Berlowitz, MD, MPH
Arch Intern Med. 2005;165:2631-2638.
Background Emerging evidence indicates that patients with mental health conditions (MHCs) may receive less intensive medical care. Diabetes serves as a useful condition in which to test for MHC-related disparities in care. We examined whether quality measures for diabetes care are worse for patients with or without MHCs.
Methods This national, cross-sectional study included 313 586 noninstitutionalized Veterans Health Administration patients with diabetes (identified from diagnostic codes and prescriptions) whose Veterans Health Administration facility transmitted laboratory data to a central database; 76 799 (25%) had MHCs (based on diagnostic codes for depressed mood, anxiety, psychosis, manic symptoms, substance use disorders, personality disorders, and other categories). National data from Veterans Health Administration records, Medicare claims, and a national survey were linked to characterize 1999 diabetes care.
Results Failure to meet diabetes performance measures was more common in patients with MHCs: unadjusted odds ratio (95% confidence interval) was 1.24 (1.22-1.27) for no hemoglobin A1c testing, 1.25 (1.23-1.28) for no low-density lipoprotein cholesterol testing, 1.05 (1.03-1.07) for no eye examination, 1.32 (1.30-1.35) for poor glycemic control, and 1.17 (1.15-1.20) for poor lipemic control. Disparities persisted after case mix adjustment and were more pronounced with specific MHCs (psychotic, manic, substance use, and personality disorders). The percentage not meeting diabetes care standards increased with increasing number of MHCs.
Conclusion Patients with mental illness merit special attention in national diabetes quality improvement efforts.
Author Affiliations: Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass (Drs Frayne, Halanych, Miller, Wang, Lin, Skinner, and Berlowitz); Center for Health Care Evaluation (Drs Frayne and Rosen), and National Center for PTSD (Dr Rosen), Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, Calif; Division of General Internal Medicine, Department of Medicine (Dr Frayne), and Department of Psychiatry and Behavioral Sciences (Dr Rosen), Stanford University School of Medicine, Stanford, Calif; Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (Dr Halanych); Deep South Center on Effectiveness, VA Medical Center, Birmingham (Dr Halanych); Department of Health Services, Boston University School of Public Health, Boston, Mass (Drs Miller, Wang, Lin, Skinner, and Berlowitz);Center for Healthcare Knowledge Management, VA New Jersey Healthcare System, East Orange (Dr Pogach); Department of Medicine, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark (Dr Pogach); National Center for PTSD, VA Boston Healthcare System, Boston (Drs Sharkansky and Keane); and Division of Psychiatry, Boston University School of Medicine, Boston (Drs Sharkansky and Keane).
Deceased.
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