title: Antipsychotic polytherapy on an inpatient psychiatric unit: how does clinical practice coincide with Joint Commission guidelines?
abstract: OBJECTIVE
  A recently developed quality measure set for inpatient psychiatric care includes measurement of antipsychotic polytherapy at discharge. Our objective was to use detailed chart reviews to assess the use of antipsychotic polytherapy and place this use in the context of these measures.
  
  
  METHODS
  Patients (N=75) discharged on multiple antipsychotics and a comparable set (N=114) of comparison patients (a randomly selected set of all admitted inpatients) were identified from consecutive admissions to a psychiatric inpatient unit. Medical records were reviewed to ascertain the clinical rationale for antipsychotic polytherapy and assess differences in characteristics between these groups.
  
  
  RESULTS
  Patients discharged on antipsychotic polytherapy were more likely to have public insurance, longer lengths of stay, psychotic illness, more prior admissions, and state-funded services for persons with chronic mental illness. We identified subgroups of patients based on the clinical rationale for the antipsychotic co-prescription (refractory illness, regimen unchanged from admission and use of antipsychotic for nonpsychosis symptoms). Some, but not all, such rationales appeared to be clinically justified.
  
  
  CONCLUSIONS
  The majority of patients discharged on antipsychotic polytherapy had justifiable clinical rationales that were concordant with the new quality measures. However, two additional subsets were identified, one where quality improvement efforts may be warranted and another where revision of existing quality measure definitions should be considered. Given the implications of public reporting of quality measures, further study and refinement of these measures are required to provide meaningful information to all concerned stakeholders.
authors.affiliation: Harvard Medical School, Boston, MA 02115, USA. jhuffman@partners.org
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman
authors.forename: Trina E
authors.initials: TE
authors.lastname: Chang
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Durham
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Weiss
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D017211:Treatment Failure; D014481:United States
chemical_list: D014150:Antipsychotic Agents