Developing Quality Measures for Medicaid Beneficiaries with Schizophrenia: Final Report. III. Summary of Key Findings


The purpose of this measure development project was to identify, specify, and test at least three measures that address pharmacological treatment, psychosocial treatment, and physical health needs for patients with schizophrenia that can be calculated solely from Medicaid claims data. Ten measures met our rigorous criteria for measure development, including evidence review, consultation with the TAG, focus groups with key stakeholders, public comment, and pilot-testing using the MAX data.

Tables III.1-III.4 list the measure concepts that we considered based on the environmental scan and initial input from the TAG; these concepts addressed the domains requested by ASPE (pharmacology, psychosocial treatment, and physical health) as well as a set of cross-cutting issues identified through the scan. We did not further pursue some of these topics because we did not believe that they could be assessed in claims; these measure concepts were not presented to the TAG (see Appendix B).

Based on TAG recommendations, 13 measures were specified. Two (use of any psychosocial treatment and HIV screening) were dropped before testing in the MAX files. The psychosocial treatment measure was dropped because procedure codes used in claims data are ambiguous and thus do not provide sufficient detail to reflect the actual service provided, and because these codes are not used consistently in different states and programs. The HIV screening measure was dropped because of the lack of strong evidence suggesting a gap in care for people with schizophrenia. Based on the input received from the public comment period, we dropped the measure of general ED utilization due to provider attribution concerns, which resulted in ten measures that were later pilot-tested in the MAX data.

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