Disparities in quality of care among publicly insured adults with schizophrenia in four large U.S. states, 2002-2008

Abstract

Objective: To examine racial/ethnic disparities in quality of schizophrenia care and assess the size of observed disparities across states and over time.

Data sources: Medicaid claims data from CA, FL, NY, and NC.

Study design: 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.

Principal findings: 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.

Conclusions: 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.

Keywords: Medicaid; Racial/ethnic disparities; quality of care; schizophrenia; trends.

Figure 1

Distribution of Standardized Composite Score, by State Note. y-axis displays the relative frequency of composite scores. Lower x-axis denotes the composite scale while upper x-axis expresses the composite as the expected percentage of process indicators met. Solid vertical line indicates state mean.

Figure 2

Expected Average Standardized Composite Score, by Year and Race/Ethnicity Group Note. Point estimates obtained from linear regression models. Solid black horizontal line represents average for state. Left-most y-axis provides composite scale while right-most y-axis provides the expected percentage of process indicators met.