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Alexander S. Young, MD, MSHS; Greer Sullivan, MD, MSPH; M. Audrey Burnam, PhD; Robert H. Brook, MD, ScD

Arch Gen Psychiatry. 1998;55:611-617.

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 in treatment for schizophrenia at 2 public mental health clinics. Appropriate medication management was defined according to criteria derived from national treatment recommendations, and focused on recent management of symptoms and side effects. Adequate psychosocial care was defined as the recent provision of case management or family management to patients for whom it is indicated. Care was evaluated using patient interviews and medical records abstractions.

Results  Although patients at the 2 clinics had similar illnesses, the treatment they received was quite different. In total, 84 (38%) of patients received poor-quality medication management, and 117 (52%) had inadequate psychosocial care. Clinics differed in the proportion of patients receiving poor-quality medication management not attributable to patient factors (28% vs 16%). The clinic with better-quality medication management provided case management to fewer severely ill patients (48% vs 81%). More than half of the cases of poor care would not have been detected if we had used only medical records data.

Conclusions  At these clinics, many schizophrenic patients were receiving poor-quality care and most poor care was likely due to factors that can be modified. One approach to improving care begins by developing systems that monitor quality. These systems may require improved medical records and patient-reported symptoms and side effects.

From the Department of Psychiatry and Center for Health Services, University of California Los Angeles (Drs Young and Brook); the West Los Angeles Veterans Affairs Medical Center (Dr Young), Los Angeles; the Little Rock Veterans Affairs Medical Center and the University of Arkansas for Medical Science, Little Rock (Dr Sullivan); and the Health Program, RAND Corporation, Santa Monica, Calif (Drs Young, Sullivan, Burnam, and Brook).

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