Quality of medical care for persons with serious mental illness: A comprehensive review.
OBJECTIVE
Prior studies suggest variation in the quality of medical care for somatic conditions such as cardiovascular disease and diabetes provided to persons with SMI, but to date no comprehensive review of the literature has been conducted. The goals of this review were to summarize the prior research on quality of medical care for the United States population with SMI; identify potential sources of variation in quality of care; and identify priorities for future research.


METHODS
Peer-reviewed studies were identified by searching four major research databases and subsequent reference searches of retrieved articles. All studies assessing quality of care for cardiovascular disease, diabetes, dyslipidemia, and HIV/AIDs among persons with schizophrenia and bipolar disorder published between January 2000 and December 2013 were included. Quality indicators and information about the study population and setting were abstracted by two trained reviewers.


RESULTS
Quality of medical care in the population with SMI varied by study population, time period, and setting. Rates of guideline-concordant care tended to be higher among veterans and lower among Medicaid beneficiaries. In many study samples with SMI, rates of guideline adherence were considerably lower than estimated rates for the overall US population.


CONCLUSIONS
Future research should identify and address modifiable provider, insurer, and delivery system factors that contribute to poor quality of medical care among persons with SMI and examine whether adherence to clinical guidelines leads to improved health and disability outcomes in this vulnerable group.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, United States. Electronic address: bmcginty@jhu.edu.
Emma E
EE
McGinty
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, United States. Electronic address: jballer@jhu.edu.
Julia
J
Baller
National Institute of Mental Health, United States. Electronic address: Susan.Azrin@nih.gov.
Susan T
ST
Azrin
Johns Hopkins Medical Institutions, Division of General Internal Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, United States. Electronic address: Djuliano@mail.nih.gov.
Denise
D
Juliano-Bult
Johns Hopkins Medical Institutions, Division of General Internal Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, United States. Electronic address: gdaumit@jhmi.edu.
Gail L
GL
Daumit
D016208:Databases, Factual / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010346:Patient Care Management / Q000379:methods* / Q000592:standards*
Bipolar disorder; Quality of care; Schizophrenia