title: The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans.
abstract: OBJECTIVE
  The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector.
  
  
  METHODS
  Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484). The authors computed VA and MarketScan national means for seven process-based quality measures related to medication evaluation and management and estimated national-level performance by age and gender.
  
  
  RESULTS
  In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment.
  
  
  CONCLUSIONS
  Findings demonstrate the significant advantages that accrue from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Watkins
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Brad
authors.initials: B
authors.lastname: Smith
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Ayse
authors.initials: A
authors.lastname: Akincigil
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Melony E
authors.initials: ME
authors.lastname: Sorbero
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Susan
authors.initials: S
authors.lastname: Paddock
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Abigail
authors.initials: A
authors.lastname: Woodroffe
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Huang
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
authors.affiliation: Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: kwatkins@rand.org ). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
authors.forename: Harold Alan
authors.initials: HA
authors.lastname: Pincus
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D017149:Private Sector / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D055815:Young Adult