{Reference Type}: Journal Article
{Title}: Using an explicit guideline-based criterion and implicit review to assess antipsychotic dosing performance for schizophrenia.
{Author}: Owen RR;Thrush CR;Hudson TJ;Mallory SR;Fischer EP;Clardy JA;Williams DK;
{Journal}: Int J Qual Health Care
{Volume}: 14
{Issue}: 3
{Year}: Jun 2002
{Factor}: 2.257
{DOI}: 10.1093/oxfordjournals.intqhc.a002611
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>METHODS: </B>A total of 66 patients hospitalized for acute schizophrenia at a Veterans Affairs medical center or state hospital in the southeastern US.<BR><B>METHODS: </B>The sensitivity and specificity of the explicit dose criterion at hospital discharge were determined in comparison with the gold standard of structured implicit review.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.