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Performance measurement for schizophrenia: adherence to guidelines for antipsychotic dose

RICHARD R OWEN, CAROL R THRUSH, JOANN E KIRCHNER, ELLEN P FISCHER, BRENDA M BOOTH
DOI: http://dx.doi.org/10.1093/intqhc/12.6.475 475-482 First published online: 1 December 2000

Abstract

Objective. This report describes the development, application, and exploratory evaluation of a clinical performance measure based on recently published schizophrenia guidelines for antipsychotic dose. Design, setting, participants. The performance measure, which assesses adherence to antipsychotic dose recommendations for acute schizophrenia treatment, was calculated at hospital discharge for 116 patients with schizophrenia who had participated in a 6-month outcomes study. Main outcome measure. The Brief Psychiatric Rating Scale (BPRS) was used to assess symptom severity at 6-month follow-up. Results. At discharge, almost one-half of the patients were prescribed doses outside the recommended range. For the entire sample, linear regression models showed that the performance measure variable was not significantly associated with follow-up symptom severity (BPRS total scores). However, a significant association was observed for patients prescribed oral antipsychotics only (n=69). Patients prescribed recommended doses had lower adjusted mean BPRS totals than patients prescribed doses either greater than (P < 0.05) or less than (P < 0.05) recommended. Conclusions. Our findings suggest that the antipsychotic dose performance measure may be useful for monitoring quality. It assesses a modifiable aspect of care for which clinical improvement is needed, and such improvement is likely to improve patient outcomes. Future research is needed to confirm our findings and to develop and test interventions to improve the quality of care for schizophrenia that incorporate this clinical performance measure.