Session number: 1052
Abstract title: Mental Disorders and the Quality of Diabetes Care in the Veterans Health Administration
Author(s):
MM Desai - VA Northeast Program Evaluation Center, West Haven, CT; and Department of Psychiatry, Yale University School of Medicine, New Haven, CT
RA Rosenheck - VA Northeast Program Evaluation Center, West Haven, CT; and Department of Psychiatry, Yale University School of Medicine, New Haven, CT
BG Druss - VA Northeast Program Evaluation Center, West Haven, CT; and Department of Psychiatry, Yale University School of Medicine, New Haven, CT
JB Perlin - VHA Office of Quality and Performance, Washington, DC
Objectives: Persons with mental disorders represent a population that is potentially vulnerable to poorer quality of medical care. The objective of this study is to examine the relationship between mental disorders and quality of diabetes care in a national sample of veterans.
Methods: Chart-abstracted quality data from the VA's External Peer Review Program were merged with outpatient and inpatient administrative database records for a sample of veterans with diabetes who had at least three medical outpatient visits in the previous year (N=38,020). Mental health diagnoses were identified using the administrative data. Quality of diabetes care was assessed using five indicators: chart documentation of annual foot inspection, pedal pulses examination, foot sensory examination, retina examination, and glycated hemoglobin determination.
Results: Approximately a quarter of the sample had a diagnosed mental disorder (23.7% psychiatric disorder only, 1.3% substance use disorder only, and 2.6% dual diagnosis). Overall rates of receipt for the indicators were higher than national benchmarks for all patient subgroups, ranging from 70.8% for retina examination to 95.0% for foot inspection. Rates for both retina examination and foot sensory examination differed significantly but modestly by mental health status, mainly due to lower rates among those with a substance use disorder. The associations remained significant in multivariate generalized estimating equation analyses that controlled for demographics, health status, use of medical services, and facility-level characteristics.
Conclusions: Rates for secondary prevention of diabetes were remarkably high at VA medical centers, although patients with mental disorders (particularly substance use disorders) were somewhat less likely to receive some of the recommended interventions.
Impact statement: Strategies, such as case management, extra time for office visits, and other interventions, developed for the management of chronic illnesses may need to be adapted for use in patients with substance use disorders. More work is needed to develop and test models for improving care in this vulnerable population.