Changes Over Time and Disparities in Schizophrenia Treatment Quality

Background: Schizophrenia medication and psychosocial treatment options have expanded since the Schizophrenia PORT was conducted. However, there also have been considerable changes in the delivery of mental health care in the public sector, as well as increasing state concerns about Medicaid cost containment. Objectives: To examine trends and patient characteristics associated with differences in schizophrenia medication and visit treatment quality in a Medicaid population. Research Design: Observational study of claims data from July 1, 1996 to June 30, 2001. Subjects: Florida Medicaid enrollees diagnosed with schizophrenia (N = 23,619). Measures: We examined the likelihood of meeting any I and all 4 of the following quality standards: (1) receiving antipsychotic medication, (2) antipsychotic continuity, (3) closing consistent with PORT recommendations, and (4) mental health visit continuity. Separate models were fit for acute and maintenance phases of treatment. Results: Approximately 18% of acute and 7% of maintenance phases met all 4 quality standards. Antipsychotic quality improved (largely driven by an increasingly likelihood of receiving any antipsychotic), while visit continuity declined. The greatest disparities were seen for persons with co-occurring substance use disorders and of black race. Quality differences were often phase specific and at times in opposite directions across treatment phases. Conclusions: The improvement in antipsychotic treatment quality is encouraging. However, visit continuity declined. This study highlights the importance of quality measurement that includes focus on different treatment modalities and phases of care, as well as for potentially vulnerable populations (such as persons with co-occurring substance use disorders and racial/ethnic minorities).