Disparities in Quality of Care among Publicly Insured Adults with Schizophrenia in Four Large U.S. States, 2002–2008
Article first published online: 13 MAR 2014
© Health Research and Educational Trust
Health Services Research
Volume 49, Issue 4, pages 1121–1144, August 2014
How to Cite
Horvitz-Lennon, M., Volya, R., Donohue, J. M., Lave, J. R., Stein, B. D. and Normand, S.-L. T. (2014), Disparities in Quality of Care among Publicly Insured Adults with Schizophrenia in Four Large U.S. States, 2002–2008. Health Services Research, 49: 1121–1144. doi: 10.1111/1475-6773.12162
- Issue published online: 23 JUL 2014
- Article first published online: 13 MAR 2014
- National Institute of Mental Health
- Racial/ethnic disparities;
- quality of care;
To examine racial/ethnic disparities in quality of schizophrenia care and assess the size of observed disparities across states and over time.
Medicaid claims data from CA, FL, NY, and NC.
Observational repeated cross-sectional panel cohort study of white, black, and Latino fee-for-service adult beneficiaries with schizophrenia. Main outcome was the relationship of race/ethnicity and year with a composite measure of quality of schizophrenia care derived from 14 evidence-based quality indicators.
Quality was assessed for 325,373 twelve-month person-episodes between 2002 and 2008, corresponding to 123,496 Medicaid beneficiaries. In 2002, quality was lowest for blacks in all states. With the exception of FL, quality was lower for Latinos than whites. In CA, blacks had about 43 percent of the individual indicators met compared to 58 percent for whites. Quality improved annually for all groups in CA, NY, and NC. While in CA the improvement was slightly larger for Latinos, in FL quality improved for blacks but declined for Latinos and whites.
Quality of schizophrenia care is poor and racial/ethnic disparities exist among Medicaid beneficiaries from four states. The size of the disparities varied across the states, and most of the initial disparities were unchanged by 2008.