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    Behavioral Health Disorders and the Quality of Diabetes Care: A Dissertation

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    Authors
    Leung, Yat (Gary) Hung
    Faculty Advisor
    Robin E. Clark, Ph.D.
    Academic Program
    Clinical and Population Health Research
    UMass Chan Affiliations
    Family Medicine and Community Health
    Document Type
    Doctoral Dissertation
    Publication Date
    2010-03-02
    Keywords
    Mental Disorders
    Diabetes Mellitus
    Comorbidity
    Quality of Health Care
    Massachusetts
    Medicare
    Medicaid
    Endocrine System Diseases
    Endocrinology, Diabetes, and Metabolism
    Health Services Administration
    Health Services Research
    Insurance
    Mental Disorders
    Nutritional and Metabolic Diseases
    Psychiatry and Psychology
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    Abstract
    Both diabetes and behavioral health disorders (mental and substance use disorders) are significant health issues in the United States. While previous studies have shown worse health outcomes in people with diabetes and co-occurring behavioral health disorders (BHDs) than those with diabetes alone, it is unclear whether the quality of diabetes care was poorer in the presence of co-occurring BHDs. Although previous research has observed a trend of positive outcomes in people with comprehensive diabetes care, there is a lack of evidence about whether that mode of care delivery can improve outcomes in people with co-occurring BHDs. Therefore, further studies are necessary. Using a combined dataset from Medicare and Medicaid claims for Massachusetts residents, this study compared the quality of diabetes care (e.g., having at least 1 hemoglobin A1c test) and diabetes outcomes (e.g., eye complications) among Medicare and Medicaid beneficiaries with diabetes and co-occurring BHDs to those with diabetes alone in Massachusetts in 2005. The results showed a mixed picture on the relationships between BHDs and diabetes outcomes. While substance use disorders had adverse impact on adherence to quality measures (e.g., 20% less likely to attain full adherence, p0.05). Findings from this dissertation research suggest that disparities exist in the quality of diabetes care and health outcomes between people with substance use disorders and those without. The mode of care delivery needs to be further examined so that interventions can be designed to improve the outcomes of people with diabetes.
    DOI
    10.13028/r00y-aw61
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/31786
    Rights
    Copyright is held by the author, with all rights reserved.
    ae974a485f413a2113503eed53cd6c53
    10.13028/r00y-aw61
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    Morningside Graduate School of Biomedical Sciences Dissertations and Theses

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