Routine quality care assessment of schizophrenic disorders using information systems

Abstract

Objective: To assess the quality of mental healthcare provided to patients with schizophrenic disorders in the Italian region of Lombardy.

Design: Forty-one clinical indicators were applied to Lombardy's healthcare databases containing data on mental health treatments, hospital admissions, somatic health treatments and pharmaceutical prescriptions.

Setting: All public departments of mental health and private residential facilities in Lombardy.

Participants: All 28 227 patients with schizophrenic disorders that were under the care of Lombardy mental health services in 2009.

Interventions: N/A.

Main outcome measures: N/A.

Results: The care that was delivered to patients and family members was more frequent for first-episode cases than for prevalent ones. Seven out of ten patients made use of continuing care and, after hospitalization, more than half of the discharged patients received a follow-up visit by community mental health centre staff within 2 weeks of their discharge. Psychotherapeutic and psychoeducative treatments, such as employment and independent living support, were not widespread among these discharged patients. Antipsychotic drug dosage was usually within the recommended range. The adherence of first-episode patients to antipsychotic treatment was lower than that of prevalent patients, and the monitoring of metabolic side effects was not always consistent. Inappropriateness of hospital care, in terms of longer admission, readmission, compulsory admission and restraint, was limited. Mortality during the period was significant.

Conclusions: Clinical indicators demonstrate the strengths and weaknesses of the mental health system in Lombardy and they can be useful tools in the routine assessment of mental healthcare quality.

Keywords: appropriateness; quality indicators; quality management; under-use and over-use.