Performance measurement for schizophrenia: adherence to guidelines for antipsychotic dose.
OBJECTIVE
This report describes the development, application, and exploratory evaluation of a clinical performance measure based on recently published schizophrenia guidelines for antipsychotic dose.


METHODS
The performance measure, which assesses adherence to antipsychotic dose recommendations for acute schizophrenia treatment, was calculated at hospital discharge for 116 patients with schizophrenia who had participated in a 6-month outcomes study.


METHODS
The Brief Psychiatric Rating Scale (BPRS) was used to assess symptom severity at 6-month followup.


RESULTS
At discharge, almost one-half of the patients were prescribed doses outside the recommended range. For the entire sample, linear regression models showed that the performance measure variable was not significantly associated with followup symptom severity (BPRS total scores). However, a significant association was observed for patients prescribed oral antipsychotics only (n = 69). Patients prescribed recommended doses had lower adjusted mean BPRS totals than patients prescribed doses either greater than (P < 0.05) or less than (P < 0.05) recommended.


CONCLUSIONS
Our findings suggest that the antipsychotic dose performance measure may be useful for monitoring quality. It assesses a modifiable aspect of care for which clinical improvement is needed, and such improvement is likely to improve patient outcomes. Future research is needed to confirm our findings and to develop and test interventions to improve the quality of care for schizophrenia that incorporate this clinical performance measure.
Owen
R R
RR
HSR & D Center for Mental Healthcare and Outcomes Research (CeMHOR), Central Arkansas Veterans Healthcare System, Little Rock 72114-1706, USA. OwenRichardR@exchange.uams.edu
Thrush
C R
CR
Kirchner
J E
JE
Fischer
E P
EP
Booth
B M
BM
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D011569:Psychiatric Status Rating Scales; D019984:Quality Indicators, Health Care; D012559:Schizophrenia / Q000188:drug therapy*; D012720:Severity of Illness Index; D014481:United States
D014150:Antipsychotic Agents