Original ContributionImplementing composite quality metrics for bipolar disorder: towards a more comprehensive approach to quality measurement☆
Section snippets
Background
Bipolar disorder is a chronic illness affecting up to 5.5% of the population [1] and is associated with substantial functional limitations [2], [3] and health care costs [4], [5]. Persons with bipolar disorder often require intensive pharmacologic and psychosocial treatment [2], because the illness is uniquely characterized by alternating periods of mania and depression, which can lead to treatment interruptions and self-medication with substance abuse that impede overall treatment adherence [6]
Study population and sample
We analyzed data from a longitudinal, naturalistic, population-based study of 435 veterans with mood disorders [19]. The target population was patients being treated for bipolar disorder presenting for inpatient or outpatient care during a 2-year period (July 2004–July 2006) at a large VA mental health facility. Patients who were clinically diagnosed with bipolar disorder (including bipolar I disorder as well as the spectrum disorders including bipolar II or schizoaffective disorder–bipolar
Results
The sample (N=433) was 86% male, 77% white and had a mean age of 49 years (range 21–78). Overall, 74% of the sample was diagnosed with bipolar I, 9% diagnosed with bipolar II and 17% diagnosed with schizoaffective disorder-bipolar subtype. Half (54%) reported a history of homelessness and 28% reported a history of illicit drug use (Table 2).
The denominator was the same for each indicator (N=433). Overall, 17% had documented assessment of all symptoms (delusional, psychotic, hallucinatory), 56%
Discussion
To our knowledge, this is one of the few studies to apply operationalized processes of care that represent a wider range of services beyond medication use for patients with bipolar disorder and determine the patient factors associated with receipt of adequate processes of care in this group. This is also one of the first studies to propose patient-centered composite measures for assessing quality of care for bipolar disorder. We found that, although certain aspects of bipolar care were
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This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (IIR 02-283) and by the National Institute of Mental Health (MH 74509; MH 79994, T32 MH19986). The funding source had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. All authors warrant having no actual or perceived conflicts of interest — financial or nonfinancial — in the procedures described in this manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.