Study Suggests Lower Quality of Care for Cardiometabolic Disease among Veterans with Mental Disorders, Regardless of Rural or Urban Dwelling
Rural residence is often associated with lower levels of health services use, higher prevalence of certain diseases, and in some cases, a lesser quality of health care services. Serious mental disorders and depression have been associated with increased cardiometabolic disease and mortality that may result from, among other factors, disparities in access to, and quality of, medical care. Rural residence and MD comprise distinct risk factors for potential receipt of lower care quality. This study examined quality of cardiometabolic care among 35,468 Veterans with mental disorders (MD) in an effort to assess whether quality of care disparities by MD status are magnified for rural dwelling residents.
Investigators used a retrospective cohort of all patients in a 2005 national VA cardiometabolic quality of care chart review that included Veterans with and without MD. Using residential ZIP codes, patients were assigned to a Rural-Urban Commuting Area code. Investigators then assessed the association between rural residence and nine cardiometabolic care quality indicators, including care processes and outcomes.
Findings showed that MD is associated with decreased likelihood of obtaining quality cardiometabolic care. When compared to those without MD, Veterans with MD were less likely to receive diabetes sensory foot exams, retinal exams, and renal tests. Rural residence was associated with no differences in quality measures. Primary care visit volume was associated with a greater likelihood of obtaining diabetic retinal exam and renal testing, but did not explain disparities among patients with MD.
Morden N, Berke E, Welsh D, McCarthy J, Mackenzie T, Kilbourne A. Quality of Care for Cardiometabolic Disease: Associations with Mental Disorder and Rurality. Medical Care January 2010;(48)1:72-78.
Ms. Welsh and Drs. McCarthy and Kilbourne are part of HSR&D's Center for Clinical Management Research in Ann Arbor, MI.