Performance measurement for schizophrenia: adherence to guidelines for antipsychotic dose

Objective. This report describes the development, application, and explorat ory evaluation of a clinical performance measure based on recently publishe d schizophrenia guidelines for antipsychotic dose. Design, setting, participants. The performance measure, which assesses adhe rence to antipsychotic dose recommendations for acute schizophrenia treatme nt, was calculated at hospital discharge for 116 patients with schizophreni a who had participated in a 6-month outcomes study. Main outcome measure. The Brief Psychiatric Rating Scare (BPRS) was used to assess symptom severity at 6-month follow-up. Results. At discharge, almost one-half of the patients were prescribed dose s outside the recommended range. For the entire sample, linear regression m odels showed that the performance measure variable was not significantly as sociated with follow-up symptom severity (BPRS total scores). However, a si gnificant association was observed for patients prescribed oral antipsychot ics only (n=69). Patients prescribed recommended doses had lower adjusted m ean BPRS totals than patients prescribed doses either greater than (P < 0.0 5) or less than (P < 0.05) recommended. Conclusions. Our findings suggest that the antipsychotic dose performance m easure may be useful for monitoring quality. It assesses a modifiable aspec t of care for which clinical improvement is needed, and such improvement is likely to improve patient outcomes. Future research is needed to confirm o ur findings and to develop and test interventions to improve the quality of care for schizophrenia that incorporate this clinical performance measure.