Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series

VI. ADHERENCE TO PORT PHARMACOTHERAPY GUIDELINES FOR PATIENTS WITH SCHIZOPHRENIA

Percentage of patients receiving oral antipsychotic medication (81%).

Percentage of veterans dosed higher than recommended guidelines (12.3%)

Percentage of veterans dosed lower than recommended guidelines (28.6%)

Percentage of patients receiving polypharmacy (two antipsychotic medications)(8.1%)

VII. OUTCOMES ON THE GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE

Improvement after inpatient discharge

Change from inpatient GAF to last outpatient GAF in first six months after discharge (4.9)

Change from inpatient GAF to the last outpatient GAF of the fiscal year (6.4)

Improvement after during outpatient treatment

Change from first outpatient GAF to last outpatient GAF in the next 6 months (0.46)

Change from first outpatient GAF to last outpatient GAF of the fiscal year (0.33)

Change from first outpatient GAF in the second 6 months of the fiscal year to the last outpatient GAF of the fiscal year (0.38)

Among newly admitted outpatient veterans (those with no outpatient mental health visits in the first 3 months of the fiscal year) the change from first outpatient GAF to last outpatient GAF of the fiscal year (1.9)

Table of Contents

Front Matter R1-R24

Summary 1-28

1 The Quality Chasm in Health Care for Mental and Substance-Use Conditions 29-55

2 A Framework for Improving Quality 56-76

3 Supporting Patients' Decision-Making Abilities and Preferences 77-139

4 Strengthening the Evidence Base and Quality Improvement Infrastructure 140-209

5 Coordinating Care for Better Mental, Substance-Use, and General Health 210-258

6 Ensuring the National Health Information Infrastructure Benefits with Mental and Substance-Use Conditions 259-285

7 Increasing Workforce Capacity for Quality Improvement 286-324

8 Using Marketplace Incentives to Leverage Needed Change 325-349

9 An Agenda for Change 350-390

Appendix A: Study Process and Committee Membership 391-404

Appendix B: Contraints on Sharing Mental Health and Substance Use Treatment Information Imposed by Federal and State Medical Records Privacy Laws 405-422

Appendix C: Mental and Substance Use Health for Veterans: Experience with Performance Evaluation in the Department of Veterans Affairs 423-482

Index 483-504

VI. ADHERENCE TO PORT PHARMACOTHERAPY GUIDELINES FOR PATIENTS WITH SCHIZOPHRENIA

VII. OUTCOMES ON THE GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE