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Published Online: 16 November 2015

The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans

Katherine E. Watkins, M.D., M.S.H.S., Brad Smith, Ph.D., Ayse Akincigil, Ph.D., Melony E. Sorbero, Ph.D., Susan Paddock, Ph.D., Abigail Woodroffe, Ph.D., Cecilia Huang, Ph.D., Stephen Crystal, Ph.D., and Harold Alan Pincus, M.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 67, Number 4
https://doi.org/10.1176/appi.ps.201400537
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Abstract

Objective:

The quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) was compared with care provided to a comparable population treated in the private sector.

Methods:

Two cohorts of individuals with mental disorders (schizophrenia, bipolar disorder, posttraumatic stress disorder, major depression, and substance use disorders) were created with VA administrative data (N=836,519) and MarketScan data (N=545,484). The authors computed VA and MarketScan national means for seven process-based quality measures related to medication evaluation and management and estimated national-level performance by age and gender.

Results:

In every case, VA performance was superior to that of the private sector by more than 30%. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment.

Conclusions:

Findings demonstrate the significant advantages that accrue from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.

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Information & Authors

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Cover: Fame Weathervane, by E.G. Washburne and Company, circa 1890. Copper and zinc with gold leaf. American Folk Art Museum, Long Island City, New York. Gift of Ralph Esmerian, accession number 2005.8.62. Photo credit: Gavin Ashworth.

Psychiatric Services
Volume 67 • Number 4 • April 01, 2016
Pages: 391 - 396
PubMed: 26567931

History

Received: 24 November 2014
Revision received: 15 May 2015
Accepted: 1 July 2015
Published online: 16 November 2015
Published in print: April 01, 2016

Authors

Details

Katherine E. Watkins, M.D., M.S.H.S.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
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Brad Smith, Ph.D.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
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Ayse Akincigil, Ph.D.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
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Melony E. Sorbero, Ph.D.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
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Susan Paddock, Ph.D.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
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Abigail Woodroffe, Ph.D.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
View all articles by this author
Cecilia Huang, Ph.D.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
View all articles by this author
Stephen Crystal, Ph.D.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
View all articles by this author
Harold Alan Pincus, M.D.
Dr. Watkins, Dr. Sorbero, Dr. Paddock, and Dr. Pincus are with RAND Corporation, Santa Monica, California (e-mail: [email protected]). Dr. Pincus is also with the Department of Psychiatry College of Physicians and Surgeons, Columbia University, New York City. Dr. Smith is with IMPAQ International, Columbia, Maryland. Dr. Akincigil and Dr. Huang are with the Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey. Dr. Akincigil is also with the School of Social Work, Rutgers University. Dr. Woodroffe is with IMPAQ International, Wellesley, Massachusetts. Dr. Crystal is with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Rutgers University.
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Notes

Some of the findings were presented at the 21st National Institute of Mental Health Conference on Mental Health Services Research, Washington, DC, July 11, 2011.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

U.S. Department of Veterans Affairs10.13039/100000738: 101-G67214/101-G67215
Altarum: SC-06-0020
RAND Corporation10.13039/100004459: HE1081
This work was funded by the U.S. Department of Veterans Affairs (contracts GS 10 F-0261K, 101-G67214/101-G67215), with additional funding by the Agency for Healthcare Research and Quality (grants U19HS021112 and R18HS03258) and by RAND Health.

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