PDF(Sci-hub)
Abstract：
OBJECTIVE: Using structured implicit review as the gold standard, this study assessed the sensitivity and specificity of an explicit antipsychotic dose criterion derived from schizophrenia guidelines.
METHODS: Two psychiatrists reviewed medical records and made consensus-structured implicit review ratings of the appropriateness of discharge antipsychotic dosages for hospitalized patients who participated in a schizophrenia outcomes study. Structured implicit review ratings were compared with the explicit criterion: whether antipsychotic dose was within the guideline-recommended range of 300-1000 chlorpromazine milligram equivalents (CPZE). In addition, reasons for deviation from guideline dose recommendations were examined.
METHODS: A total of 66 patients hospitalized for acute schizophrenia at a Veterans Affairs medical center or state hospital in the southeastern US.
METHODS: The sensitivity and specificity of the explicit dose criterion at hospital discharge were determined in comparison with the gold standard of structured implicit review.
RESULTS: At hospital discharge, 61% of patients (n = 40) were receiving doses within the guideline-recommended range. According to structured implicit review ratings, antipsychotic dose management was appropriate for 80% (n = 53) of patients. When the 300-1000 CPZE dose criterion (dosage within or outside the recommended range) was compared with structured implicit review, it demonstrated 84.6% sensitivity and 71.7% specificity for detecting inappropriate antipsychotic dose.
CONCLUSIONS: The explicit antipsychotic dose criterion may provide a useful and efficient screen to identify patients at significant risk for quality of care problems; however, the relatively low specificity suggests that the measure may not be appropriate for quality measurement programs that compare performance among health plans.
METHODS: Two psychiatrists reviewed medical records and made consensus-structured implicit review ratings of the appropriateness of discharge antipsychotic dosages for hospitalized patients who participated in a schizophrenia outcomes study. Structured implicit review ratings were compared with the explicit criterion: whether antipsychotic dose was within the guideline-recommended range of 300-1000 chlorpromazine milligram equivalents (CPZE). In addition, reasons for deviation from guideline dose recommendations were examined.
METHODS: A total of 66 patients hospitalized for acute schizophrenia at a Veterans Affairs medical center or state hospital in the southeastern US.
METHODS: The sensitivity and specificity of the explicit dose criterion at hospital discharge were determined in comparison with the gold standard of structured implicit review.
RESULTS: At hospital discharge, 61% of patients (n = 40) were receiving doses within the guideline-recommended range. According to structured implicit review ratings, antipsychotic dose management was appropriate for 80% (n = 53) of patients. When the 300-1000 CPZE dose criterion (dosage within or outside the recommended range) was compared with structured implicit review, it demonstrated 84.6% sensitivity and 71.7% specificity for detecting inappropriate antipsychotic dose.
CONCLUSIONS: The explicit antipsychotic dose criterion may provide a useful and efficient screen to identify patients at significant risk for quality of care problems; however, the relatively low specificity suggests that the measure may not be appropriate for quality measurement programs that compare performance among health plans.
摘要：
目标：使用结构化隐式审查作为黄金标准，这项研究评估了精神分裂症指南中明确的抗精神病药物剂量标准的敏感性和特异性.
方法：两名精神科医生回顾了医疗记录，并对参加精神分裂症结局研究的住院患者出院抗精神病药剂量的适当性进行了共识结构的内隐评价。将结构化的隐式审查评级与明确的标准进行比较：抗精神病药剂量是否在指南推荐的300-1000氯丙嗪毫克当量（CPZE）范围内。此外,研究了偏离指南剂量建议的原因.
方法：在美国东南部的退伍军人事务医疗中心或州立医院共66例因急性精神分裂症住院的患者。
方法：与结构化隐性审查的黄金标准相比，确定了出院时明确剂量标准的敏感性和特异性。
结果：出院时，61%的患者（n=40）接受了指南推荐范围内的剂量。根据结构化的隐性评论评级，抗精神病药物剂量管理适用于80%(n=53)的患者.当将300-1000CPZE剂量标准（建议范围内或外的剂量）与结构化隐式审查进行比较时，它显示84.6%的灵敏度和71.7%的特异性用于检测不适当的抗精神病药物剂量.
结论：明确的抗精神病药物剂量标准可以提供一个有用和有效的筛选，以确定有重大护理质量问题风险的患者；然而，相对较低的特异性表明，该措施可能不适合比较健康计划之间绩效的质量测量计划。
方法：两名精神科医生回顾了医疗记录，并对参加精神分裂症结局研究的住院患者出院抗精神病药剂量的适当性进行了共识结构的内隐评价。将结构化的隐式审查评级与明确的标准进行比较：抗精神病药剂量是否在指南推荐的300-1000氯丙嗪毫克当量（CPZE）范围内。此外,研究了偏离指南剂量建议的原因.
方法：在美国东南部的退伍军人事务医疗中心或州立医院共66例因急性精神分裂症住院的患者。
方法：与结构化隐性审查的黄金标准相比，确定了出院时明确剂量标准的敏感性和特异性。
结果：出院时，61%的患者（n=40）接受了指南推荐范围内的剂量。根据结构化的隐性评论评级，抗精神病药物剂量管理适用于80%(n=53)的患者.当将300-1000CPZE剂量标准（建议范围内或外的剂量）与结构化隐式审查进行比较时，它显示84.6%的灵敏度和71.7%的特异性用于检测不适当的抗精神病药物剂量.
结论：明确的抗精神病药物剂量标准可以提供一个有用和有效的筛选，以确定有重大护理质量问题风险的患者；然而，相对较低的特异性表明，该措施可能不适合比较健康计划之间绩效的质量测量计划。
