2057. Assessing Quality of Care for Veterans with Schizophrenia
AF Lehman, VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), AS Bellack, VA Capitol Health Care Network (VISN 5) MIRECC, J Kreyenbuhl, VA Capitol Health Care Network (VISN 5) MIRECC

Objectives: There is substantial evidence that many patients with schizophrenia, including veterans, do not receive treatment that is consistent with empirically proven treatment technologies. The primary objective of this study is to assess the quality of care (QOC) provided to veterans with schizophrenia in VISN 5 by evaluating provider adherence with the Patient Outcomes Research Team (PORT) treatment recommendations, and to link adherence to patterns of service utilization and outcomes, in order to assess the validity of the treatment recommendations as QOC standards.

Methods: Prospective patterns of service utilization, content of care, and outcomes are being assessed for a 10% random sample (n=300) of all outpatients in VISN 5 with schizophrenia, who will complete baseline and six-month follow-up outcome assessments. Patterns of service utilization and treatment recommendation adherence will be determined using information from administrative databases, medical record review, and patient report.

Results: Data on the first 101 subjects are available. The sample is 94% male and 56% African-American, with a mean age of 50 years. Conformance rates with six PORT treatment recommendations have been ascertained and compared to results from previous studies in other treatment systems. Among the study sample, 62% of patients were prescribed antipsychotic medications within the recommended dosage range. Half (51%) of patients with extrapyramidal side effects from antipsychotic medications were prescribed an antiparkinson agent.  Two thirds (68%) of patients with clinical depression were receiving antidepressant therapy.  Only one-third (31%) of patientís families have been engaged by the treatment teams. All patients reported receiving some form of psychological counseling, but only 16% were receiving vocational rehabilitation. The comparable rates of recommendation conformance in the original PORT project were respectively, 68% (NS), 46% (NS), 46% (p<.02), 37% (NS), 45%  (p<.0001), and 23% (NS).

Conclusions: Although some deficiencies in treatment for schizophrenia have been identified, these initial results also suggest better conformance within VISN 5 compared to the original PORT settings, specifically greater use of antidepressants for depressed patients and greater use of psychological counseling.

Impact: Using methodology previously developed for other treatment systems, quality of care indicators for schizophrenia are being successfully implemented in a VA treatment system.