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Normand SL, Zelevinsky K, Finnerty M, Leckman-Westin E, Chen Q, Jeong J, Abing H, Tsuei J, Horvitz-Lennon M. Racial-Ethnic Disparities in Quality of Care Among Medicaid Beneficiaries With Schizophrenia. Psychiatr Serv 2024:appips20230564. [PMID: 38863327 DOI: 10.1176/appi.ps.20230564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE The authors sought to update and expand the evidence on the quality of health care and disparities in care among Medicaid beneficiaries with schizophrenia. METHODS Adult beneficiaries of New York State Medicaid with schizophrenia receiving care during 2016-2019 were identified. Composite quality scores were derived from item response theory models by using evidence-based indicators of the quality of mental and general medical health care. Risk-adjusted racial-ethnic differences in quality were estimated and summarized as percentiles relative to White beneficiaries' mean quality scores. RESULTS The study included 71,013 beneficiaries; 42.8% were Black, 22.9% Latinx, 27.4% White, and 6.9% other race-ethnicity. Overall, 68.8% had a mental health follow-up within 30 days of discharge, and 90.2% had no preventable hospitalizations for chronic obstructive pulmonary disease or asthma. Among beneficiaries receiving antipsychotic medications, medication adherence was adequate for 43.7%. Fourteen indicators for mental and general medical health care quality yielded three composites: two for mental health care (pharmacological and ambulatory) and one for acute mental and general medical health care. Mean quality of pharmacological mental health care for Black and Latinx beneficiaries was lower than for White beneficiaries (39th and 44th percentile, respectively). For Black beneficiaries, mean quality of ambulatory mental health care was also lower (46th percentile). In New York City, Black beneficiaries received lower-quality care in all domains. The only meaningful group difference in the quality of acute mental and general medical health care indicated higher-quality care for individuals with other race-ethnicity. CONCLUSIONS Disparities in the quality of Medicaid-financed health care persist, particularly for Black beneficiaries. Regional differences merit further attention.
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Affiliation(s)
- Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Katya Zelevinsky
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Molly Finnerty
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Emily Leckman-Westin
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Qingxian Chen
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Junghye Jeong
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Haley Abing
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Jeannette Tsuei
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
| | - Marcela Horvitz-Lennon
- Department of Health Care Policy, Harvard Medical School, Boston (Normand, Zelevinsky, Abing); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston (Normand); Office of Mental Health, New York State Department of Health, Albany (Finnerty, Leckman-Westin, Chen, Jeong); Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York (Leckman-Westin); RAND, Santa Monica, California (Tsuei), and Boston (Horvitz-Lennon); Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon)
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