• Marisa E Domino, Christopher A Beadles, Jesse C Lichstein, Joel F Farley, Joseph P Morrissey, Alan R Ellis, and C Annette Dubard.
• *Department of Health Policy and Management, Gillings School of Global Public Health †Cecil G. Sheps Center for Health Services Research Center, University of North Carolina ‡Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy §Department of Health Policy and Management, Cecil G. Sheps Center for Health Services Research Center, University of North Carolina, Chapel Hill ∥Department of Informatics, Quality, and Evaluation, Community Care of North Carolina, Raleigh, NC.
• Med Care. 2014 Mar 1; 52 Suppl 3: S101-9.

BackgroundLittle is known about the quality of care received by Medicaid enrollees with multiple chronic conditions (MCCs) and whether quality is different for those with mental illness.ObjectivesTo examine cancer screening and single-disease quality of care measures in a Medicaid population with MCC and to compare quality measures among persons with MCC with varying medical comorbidities with and without depression or schizophrenia.Research DesignSecondary data analysis using a unique data source combining Medicaid claims with other administrative datasets from North Carolina's mental health system.SubjectsMedicaid-enrolled adults aged 18 and older with ≥2 of 8 chronic conditions (asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, seizure disorder, depression, or schizophrenia). Medicare/Medicaid dual enrollees were excluded due to incomplete data on their medical care utilization.MeasuresWe examined a number of quality measures, including cancer screening, disease-specific metrics, such as receipt of hemoglobin A1C tests for persons with diabetes, and receipt of psychosocial therapies for persons with depression or schizophrenia, and medication adherence.ResultsQuality of care metrics was generally lower among those with depression or schizophrenia, and often higher among those with increasing levels of medical comorbidities. A number of exceptions to these trends were noted.ConclusionsCancer screening and single-disease quality measures may provide a benchmark for overall quality of care for persons with MCC; these measures were generally lower among persons with MCC and mental illness. Further research on quality measures that better reflect the complex care received by persons with MCC is essential.

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