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Quality of Care for Cardiovascular Disease-related Conditions in Patients with and without Mental Disorders

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Abstract

Objective

We compared the quality of care for cardiovascular disease (CVD)-related risk factors for patients diagnosed with and without mental disorders.

Methods

We identified all patients included in the fiscal year 2005 (FY05) VA External Peer Review Program’s (EPRP) national random sample of chart reviews for assessing quality of care for CVD-related conditions. Using the VA’s National Psychosis Registry and the National Registry for Depression, we assessed whether patients had received diagnoses of serious mental illness (schizophrenia, bipolar disorder, or other psychoses) or depression during FY05. Using multivariable logistic regression and generalized estimating equation analyses, we assessed patient and facility factors associated with receipt of guideline concordant care for hypertension (total N = 24,016), hyperlipidemia (N = 46,430), and diabetes (N = 10,943).

Results

Overall, 70% had good blood pressure control, 90% received a cholesterol (hyperlipidemia) screen, 77% received a retinal exam for diabetes, and 63% received recommended renal tests for diabetes. After adjustment, compared to patients without SMI or depression, patients with SMI were less likely to be assessed for CVD risk factors, notably hyperlipidemia (OR = 0.58; p < 0.001), and less likely to receive recommended follow-up assessments for diabetes: foot exam (OR = 0.68; p < 0.001), retinal exam (OR = 0.65; p < 0.001), or renal testing (OR = 0.64; p < 0.001). Patients with depression were also significantly less likely to receive adequate quality of care compared to non-psychiatric patients, although effects were smaller than those observed for patients with SMI.

Conclusions

Quality of care for major chronic conditions associated with premature CVD-related mortality is suboptimal for VA patients with SMI, especially for procedures requiring care by a specialist.

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Acknowledgements

This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. We would like to acknowledge the VA Office of Quality and Performance for providing access to EPRP data (DUA #05–024).

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. VA Ann Arbor National Serious Mental Illness Treatment Research and Evaluation Center and VA Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA

    Amy M. Kilbourne PhD, MPH, Deborah Welsh MS, John F. McCarthy PhD, Edward P. Post MD, PhD & Frederic C. Blow PhD

  2. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA

    Amy M. Kilbourne PhD, MPH & Frederic C. Blow PhD

  3. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    Edward P. Post MD, PhD

Authors
  1. Amy M. Kilbourne PhD, MPH
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  2. Deborah Welsh MS
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  3. John F. McCarthy PhD
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  4. Edward P. Post MD, PhD
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  5. Frederic C. Blow PhD
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Corresponding author

Correspondence to Amy M. Kilbourne PhD, MPH.

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Kilbourne, A.M., Welsh, D., McCarthy, J.F. et al. Quality of Care for Cardiovascular Disease-related Conditions in Patients with and without Mental Disorders. J GEN INTERN MED 23, 1628–1633 (2008). https://doi.org/10.1007/s11606-008-0720-z

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  • DOI: https://doi.org/10.1007/s11606-008-0720-z

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