The purpose of this proposal is to develop national consensus criteria and a medical records abstraction instrument designed to assess the quality of care for patients with schizophrenia who are receiving acute inpatient care. Specifically we will: (1) develop theoretical models of inpatient treatment for schizophrenia and explicit criteria for assessing the quality of care; (2) obtain consensus from a national panel of treatment experts on the applicability of treatment models to actual patients and the critical values associated with each quality of care criterion; (3) develop a medical-records based research instrument for assessing the quality of care criterion; (3) develop a medical-records values associated with each quality of care criterion; (3) develop a medical-records based research instrument for assessing the quality of care delivered in inpatient settings; (4) test the feasibility, reliability, and validity of the research instrument and develop an algorithm for scoring the quality of care. The research we are proposing will develop an algorithm for scoring the quality of care. The research we are proposing will develop models that represent all aspects of inpatient treatment received by different clinical subgroups of patients. Some of the information necessary to design those models will be available from the scientific literature. Other information will require input from clinical treatment experts who have experience in the areas for which no research exists. These models will represent the first step toward national standards for the inpatient treatment of the SMI. Because of the critical importance of these models for judging the quality of care, we will convene a national panel of experts to derive a consensus on the quality standards. Having established definitions for what constitutes high quality care, we will develop a research instrument to obtain the information necessary to judge the level of quality being delivered in actual treatment settings. Because we are committed to developing a system that could be used in large scale quality of care research projects and feasibly adapted by the public and private sectors, the instrument will be designed to obtain information on a fetrospective basis from the medical record. Although the medical record has proven adequate for assessing the quality of care for general medical problems, the adequacy of psychiatric charts for such purposes remains to be tested. The adequacy of psychiatric charts depends upon the treatment models developed and criteria selected for judging quality.
