Quality of medical care for persons with serious mental illness: A comprehensive review.
Quality of medical care for persons with serious mental illness: A comprehensive review.
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DOI：
10.1016/j.schres.2015.04.010
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发表时间：
2015-07
影响因子：
4.5
通讯作者：
Daumit GL
中科院分区：
文献类型：
--
作者：
McGinty EE;Baller J;Azrin ST;Juliano-Bult D;Daumit GL
先前的研究表明，为SMI患者提供的身体状况（如心血管疾病和糖尿病）的医疗护理质量存在差异，但迄今为止尚未对文献进行全面综述。本综述的目的是总结美国SMI患者医疗质量的既往研究;确定护理质量变化的潜在来源;并确定未来研究的优先事项。通过检索四个主要的研究数据库和随后的检索文章的参考文献检索，确定了同行评议的研究。纳入了2000年1月至2013年12月期间发表的评估精神分裂症和双相情感障碍患者心血管疾病、糖尿病、血脂异常和艾滋病毒/艾滋病护理质量的所有研究。质量指标和信息的研究人口和设置由两名训练有素的审查员抽象。SMI人群的医疗护理质量因研究人群、时间段和环境而异。指南一致性护理的比率在退伍军人中往往较高，在医疗补助受益人中较低。在许多SMI研究样本中，指南依从率大大低于美国一般人群的估计依从率。未来的研究应确定和解决可修改的供应商，保险公司和交付系统的因素，有助于低质量的医疗服务与SMI的人之间，并考虑如何最好地使用质量绩效指标的一部分，更大的战略，以改善这一群体的健康。
Prior studies suggest variation in the quality of medical care for somatic conditions such as cardiovascular disease and diabetes provided to persons with SMI, but to date no comprehensive review of the literature has been conducted. The goals of this review were to summarize the prior research on quality of medical care for the United States population with SMI; identify potential sources of variation in quality of care; and identify priorities for future research. Peer-reviewed studies were identified by searching four major research databases and subsequent reference searches of retrieved articles. All studies assessing quality of care for cardiovascular disease, diabetes, dyslipidemia, and HIV/AIDs among persons with schizophrenia and bipolar disorder published between January 2000 and December 2013 were included. Quality indicators and information about the study population and setting were abstracted by two trained reviewers. Quality of medical care in the population with SMI varied by study population, time period, and setting. Rates of guideline-concordant care tended to be higher among veterans and lower among Medicaid beneficiaries. In many study samples with SMI, rates of guideline adherence were considerably lower than estimated rates for the general US population. Future research should identify and address modifiable provider, insurer, and delivery system factors that contribute to poor quality of medical care among persons with SMI and consider how to best use quality performance measures as part of the larger strategy to improve health for this group.