Benchmarking treatment of schizophrenia - A comparison of service deliveryby the national government and by state and local providers

This study compared treatment of schizophrenia in two types of organization : a national, government-operated health care system, the Department of Vet erans Affairs (VA), and in hospitals and clinics operated by state and loca l providers. Between 1994 and 1996, 746 male patients with a clinical diagn osis of schizophrenia residing in two states in the Southeast and Midwest w ere surveyed: 192 VA inpatients were compared with 96 non-VA inpatients, an d 274 VA outpatients were compared with 184 non-VA outpatients. VA patients were older and had higher incomes than non-VA patients but did not differ significantly on measures of clinical status, satisfaction with providers, or community adjustment. VA outpatients were more likely to have been hospi talized during the previous year than non-VA outpatients and were less Like ly to have received services from a day hospital, from a case manager or so cial worker, or to have received crisis intervention services. On 5 of 26 S chizophrenic Patient Outcomes Research Team treatment recommendations, a sm aller proportion of VA than non-VA patients adhered to standards. Four of t hese reflected reduced access among VA patients to psychosocial services su ch as work therapy, job training, or case management services. Cross-sectio nal surveys can be used to compare quality of care across service systems. YA care was associated with similar satisfaction and clinical outcomes but greater reliance on hospital treatment and less use of community-based psyc hosocial services.