Quality of care for cardiometabolic disease: associations with mental disorder and rurality.

BACKGROUND: This study examines quality of cardiometabolic care among veterans receiving care in the Veterans Affairs (VA) health system. We assess whether quality of care disparities by mental disorder status are magnified for individuals living in rural areas. RESEARCH
DESIGN: We identified all patients in a 2005 national Veterans Administration cardiometabolic quality of care chart review. The intersection of this cohort and VA registries, that include patients with and without mental disorder, permitted identification of chart review patients with and without mental disorder. Using residential ZIP code, patients were assigned to rural-urban commuting area codes. We used logistic regression adjusting for age, demographics, comorbidities, and income. MEASURES: We assessed association between rural residence and 9 cardiometabolic care quality indicators including care processes and intermediate outcomes.
RESULTS: Compared with those without mental disorder, patients with mental disorder were less likely to receive diabetes sensory foot exams (OR: 0.82; 95% CI: 0.72-0.94), retinal exams (OR: 0.82; 95% CI: 0.73-0.93), and renal tests (OR: 0.79; CI: 0.74-0.90). Rural residence was associated with no differences in quality measures. Primary care visit volume was associated with significantly greater likelihood of obtaining diabetic retinal examination and renal testing, but did not explain disparities among patients with mental disorder.
CONCLUSIONS: Mental disorder is associated with lesser attainment of quality cardiometabolic care. In this integrated VA care system, rurality and visit volume did not explain this disparity. Other explanations for disparities must be explored to improve the health and health care of this population.