MEASURING THE QUALITY OF OUTPATIENT TREATMENT FOR SCHIZOPHRENIA

Background: Consumers and policy makers are increasingly interested in measuring treatment quality. We developed a standardized approach to measuring the quality of outpatient care for schizophrenia and used it to evaluate routine care. Methods: We randomly sampled 224 patients i n treatment for schizophrenia at 2 public mental health clinics. Appro priate medication management was defined according to criteria derived from national treatment recommendations, and focused on recent manage ment of symptoms and side effects. Adequate psychosocial care was defi ned as the recent provision of case management or family management to patients for whom it is indicated. Care was evaluated using patient i nterviews and medical records abstractions. Results: Although patients at the 2 clinics had similar illnesses, the treatment they received w as quite different. In total, 84 (38%) of patients received poor-quali ty medication management, and 117 (52%) had inadequate psychosocial ca re. Clinics differed in the proportion of patients receiving poor-qual ity medication management not attributable to patient factors (28% vs 16%). The clinic with better-quality medication management provided ca se management to fewer severely ill patients (48% vs 81%). More than h alf of the cases of poor care would not have been detected if we had u sed only medical records data. Conclusions: At these clinics, many sch izophrenic patients were receiving poor-quality care and most poor car e was likely due to factors that can be modified. One approach to impr oving care begins by developing systems that monitor quality. These sy stems may require improved medical records and patient-reported sympto ms and side effects.