Using Avoidable Admissions to Measure Quality of Care for Cardiometabolic and other Physical Comorbidities of Psychiatric Disorders: A Population-Based,Record-Linkage Analysis
Free accessResearch articleFirst published online November, 2015
Using Avoidable Admissions to Measure Quality of Care for Cardiometabolic and other Physical Comorbidities of Psychiatric Disorders: A Population-Based,Record-Linkage Analysis
Quality of care for comorbid physical disorders in psychiatric patients can be assessed by the number of avoidable admissions for ambulatory care sensitive (ACS) conditions. These are admissions for physical conditions that, with appropriate primary care, should not require inpatient treatment. Avoidable admissions for ACS conditions feature prominently in Australia's National Health Performance Framework and have been used to assess health care provision for marginalized groups, such as Indigenous patients or those of lower socioeconomic status. They have not been applied to people with mental illness.
Methods:
A population-based, record-linkage analysis was used to measure ACS admissions for physical disorder in psychiatric patients of state-based facilities in Queensland, Australia, during 5 years.
Results:
There were 77 435 males (48.0%) and 83 783 females (52%) (total n = 161 218). Among these, 13 219 psychiatric patients (8.2%) had at least 1 ACS admission, the most common being for diabetes (n = 6086) and angina (n = 2620). Age-standardized rates were double those of the general population. Within the psychiatric group, and after adjusting for confounders, those who had ever been psychiatric inpatients experienced the highest rates of ACS admissions, especially for diabetes.
Conclusions:
In common with other marginalized groups, psychiatric patients have increased ACS admissions. Therefore, this measure could be used as an indicator of difficulties in access to appropriate primary care in Canada, given the availability of similar administrative data.
DrussBGBradfordWDRosenheckRA, Quality of medical care and excess mortality in older patients with mental disorders. Arch Gen Psychiatry. 2001;58(6):565–572.
2.
KiselySSmithMLawrenceD, Mortality in individuals who have had psychiatric treatment. Br J Psychiatry. 2005;187:552–558.
3.
LawrenceDJablenskyAVHolmanCD. Preventable physical illness in people with mental illness. Perth (AU): University of Western Australia; 2001.
4.
BlackDW. Iowa record-linkage study: Death rates in psychiatric patients. J Affect Disord. 1998;50(2–3):277–282.
KurdyakPVigodSCalzavaraA, High mortality and low access to care following incident acute myocardial infarction in individuals with schizophrenia. Schizophr Res. 2012;142(1–3):52–57.
7.
LawrenceDHancockKKiselyS.The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: Retrospective analysis of population based registers. BMJ. 2013;346:f2539. doi: 10.1136/bmj.f2539.
LawrenceDHolmanCDJablenskyAV, Excess cancer mortality in Western Australian psychiatric patients. Acta Psychiatr Scand. 2000;101(5):382–388.
10.
KiselySSadekJMacKenzieA, Excess cancer mortality in psychiatric patients. Can J Psychiatry. 2008;53(11):753–761.
11.
LawrenceDMHolmanCDJablenskyAV, Death rate from ischaemic heart disease. Br J Psychiatry. 2003;182:31–36.
12.
CuijpersPSmitF.Excess mortality in depression: A meta-analysis of community studies. J Affect Disord. 2002;72(3):227–236.
13.
GoldmanLS. Medical illness in patients with schizophrenia. J Clin Psychiatry. 1999;60(Suppl 21):S10–S15.
14.
RobertsLRoalfeAWilsonS, Physical health care of patients with schizophrenia in primary care. Fam Pract. 2007;24(1):34–40.
15.
BurnsTCohenA.Payments for general practitioner care of severely mentally ill persons. Br J Gen Pract. 1998;48(432):1415–1416.
16.
JablenskyAMcGrathJHerrmanH, Psychotic disorders in urban areas. Aust N Z J Psychiatry. 2000;34(2):221–236.
17.
KilbourneAMWelshDMcCarthyJF, Quality of care for patients with and without mental disorders. J Gen Intern Med. 2008;23(10):1628–1633.
18.
Hippisley-CoxJParkerCCouplandC, Inequalities for patients with coronary heart disease and SMI. Heart. 2007;93(10):1256–1262.
19.
DrussBGBradfordDWRosenheckRA, Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA. 2000;283(4):506–511.
20.
KiselySSmithMLawrenceD, Inequitable access for mentally ill patients to some medically necessary procedures. CMAJ. 2007;176(6):779–784.
21.
KiselySCroweELawrenceD.Cancer-related mortality in people with mental illness. JAMA Psychiatry. 2013;70(2):209–217.
22.
MitchellAJMaloneDDoebbelingCC. Quality of medical care for people with and without comorbid mental illness and substance misuse: Systematic review of comparative studies. Br J Psychiatry. 2009;194(6):491–499.
23.
MitchellAJLawrenceD.Revascularisation and mortality rates following acute coronary syndromes in people with severe mental illness: Comparative meta-analysis. Br J Psychiatry. 2011;198(6):434–441.
24.
LawrenceDKiselyS.Inequalities in health care provision for people with severe mental illness. J Psychopharmacol. 2010;24(Suppl 4):S61–S68.
25.
KiselySCampbellLAWangY.Treatment of ischaemic heart disease and stroke in individuals with psychosis. Br J Psychiatry. 2009;195(6):545–550.
26.
CarneyCPJonesLE. The influence of type and severity of mental illness on receipt of screening mammography. J Gen Intern Med. 2006;21:1097–1104.
27.
XiongGLBermudesRATorresSN, Use of cancer-screening services among persons with serious mental illness in Sacramento County. Psychiatr Serv. 2008;59:929–932.
28.
KiselySQuekLHPaisJ, A systematic review and meta-analysis of advanced dental disease in people with severe mental illness. Br J Psychiatry. 2011;199(3):187–193.
29.
PageAAmbroseSGloverJ, Atlas of avoidable hospitalisations in Australia: Ambulatory care-sensitive conditions. Adelaide (AU): Public Health Information Development Unit, University of Adelaide; 2007.
30.
LiSQGrayNJGuthridgeSL, Avoidable hospitalisation in Aboriginal and non-Aboriginal people in the Northern Territory. Med J Aust. 2009;190(10):532–536.
31.
KatterlRAnikeevaOButlerC, Potentially avoidable hospitalisations in Australia: Causes for hospitalisations and primary health care interventions. PHC RIS Policy Issue Review. Adelaide (AU): Primary Health Care Research & Information Service; 2012.
32.
von ElmEAltmanDGEggerM, The STROBE Initiative. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–349.
TiihonenJLönnqvistJWahlbeckK, 11-year follow-up of mortality in patients with schizophrenia: A population-based cohort study (FIN11 study). Lancet. 2009;374(9690):620–627.
35.
CooryMRoselliTGkoliaP.Preliminary statistical analysis of suicides and all-cause mortality for public-sector, mental-health clients in the Sunshine Coast Health Service District, June 2004 to December 2006.Brisbane (AU): Queensland Health; 2007.
36.
NewcomerJWHauptDW. The metabolic effects of antipsychotic medications. Can J Psychiatry. 2006;51(8):480–491.
37.
AlbrechtJSHirshonJMGoldbergR, Serious mental illness and acute hospital readmission in diabetic patients. Am J Med Qual. 2012;27(6):503–508.
38.
ChengGHuangCDengH, Diabetes as a risk factor for dementia and mild cognitive impairment: A meta-analysis of longitudinal studies. Intern Med J. 2012;42(5):484–491.
39.
BlusteinJWeissLJ. Visits to specialists under Medicare: Socioeconomic advantage and access to care. J Health Care Poor Underserved. 1998;9(2):153–169.
40.
RoosLLWalldRUhanovaJ, Physician visits, hospitalisations and socioeconomic status: Ambulatory care sensitive conditions in a Canadian setting. Health Serv Res. 2005;40(4):1167–1185.
41.
GiuffridaAGravelleHRolandM.Measuring quality of care with routine data: Avoiding confusion between performance indicators and health outcomes. BMJ. 1999;319(7202):94–98.
42.
DrussBGvon EsenweinSA. Improving general medical care for persons with mental and addictive disorders: Systematic review. Gen Hosp Psychiatry. 2006;28(2):145–153.
43.
General Practice Queensland. Activate: Mind and body. Brisbane (AU): General Practice Queensland; 2009 [cited 2014 Oct 3]. Available from: http://www.activatemindandbody.com.au.
