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Study Suggests Substantial Gaps in Processes of Care for Veterans with Bipolar Disorder


Despite the availability of effective treatments and evidence-based care guidelines for bipolar disorder over the past several years, outcomes for this mental illness remain suboptimal. Reasons for suboptimal care may include poor processes of care. This study applied a comprehensive set of process of care measures that reflect the integration of psychosocial, patient preference, and continuum of care approaches to mental health – and evaluated whether Veterans with bipolar disorder received care concordant with these practices. Using VA data, including chart review, investigators assessed key processes of care for 433 Veterans with bipolar disorder who received outpatient or inpatient treatment between 7/04 and 7/06 at one large VA mental health facility. Adapted from treatment guidelines, process of care indicators included: symptom assessment, substance use/psychiatric comorbidity assessment, cardiometabolic assessment (e.g., weight, blood pressure), and patient treatment experiences (e.g., medication side effects, follow-up on no-show visits).

Findings show substantial gaps in care for Veterans with bipolar disorder, especially for patient-centered processes such as symptom assessment and treatment experience. Only half of the patients received care in accordance with clinical practice guidelines. Moreover, only 17% had documented assessment of psychiatric symptoms, 28% had documented patient treatment preferences, 56% had documented assessment of substance abuse and psychiatric comorbidity, and 62% had documented assessment of cardiometabolics. Monitoring of weight gain was noted in 54% of the patient charts, and no-show visits were followed up only 20% of the time. However, 72% of the patients received appropriate anti-manic medication, and all patients were assessed for suicidal ideation. Overall, results suggest that in order to present a more patient-centered view of quality, processes of care for bipolar disorder cannot be distilled into a single measure; but rather, a series of patient-centered composite indicators.

PubMed Logo Kilbourne A, Farmer C, Welsh D, et al. Implementing Composite Quality Metrics for Bipolar Disorder: Towards a More Comprehensive Approach to Quality Measurement. General Hospital Psychiatry November-December 2010;32(6):636-43.

This study was partly funded by HSR&D (IIR 02-283). Dr. Kilbourne is part of HSR&D’s Center for Clinical Management Research in Ann Arbor, MI.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.