Table 1

Quality of care indicators identified for people with serious mental illness

NumberDescriptionData sourceQOFAHRQReferences
Coordination of care
1Coordinated care — identify key worker (social worker or CPN)Routine data26
2Staff continuity — good communication between staff and infrequent staff changesRoutine data27
3Continuity: CONNECT is a patient questionnaire with 72 items, each rated on a five-point scale, with 13 scales and one single-item indicator: General coordination — ‘Overall, is your mental health treatment well coordinated?’ Primary care scales — ‘How often is psychiatrist in contact with your primary care doctor?’ (Never, Rarely, Sometimes, Often, Always)Primary data28
4Total number of follow-up contacts during treatment episode after initial evaluationRoutine data29
Substance misuse
5Patients with SMI who smoke who are offered tobacco counselling/help to stop smokingRoutine data25,30
6Alcohol misuse screeningRoutine data✓✓25
7Screening for illicit drug use, type, quantity, and frequencyRoutine data✓25
8Referral to substance misuse disorder specialty care, if appropriateRoutine data23
9HIV screening with co-occurring substance misuse for SMI service usersRoutine data31
Service provision and access to care
10Practice can produce register of all SMI patientsRoutine data✓32
11Service user registration with a primary health organisationRoutine data23
12Markers of care recorded: contact with secondary health services, written care plans, 6-month mental health review, identified care coordinator, evidence of physical examinationRoutine data✓33
13Patients who do not attend the practice for their annual review who are identified and followed up by the practice teamRoutine data✓✓25
14System contact: number of patients in contact with the treatment systemRoutine data23
15Surveillance to prevent relapseRoutine data27
16Crisis management and out-of-hours servicesRoutine data28
17Access to services and range of servicesRoutine data27
18Family care — record of families living with person with schizophreniaPrimary data26
19Duration of untreated psychosis: number of recently diagnosed patientsRoutine data23,34
20Waiting time between registration and start of treatmentRoutine data23
Medicines management
21All current medication clearly available at all consultations — known drug dosages, frequencies, history of side effects, review datePrimary data26
22Monitor patients suffering extra pyramidal effects, check complianceRoutine data35
23Assess weight gain, use of concomitant medicationRoutine data✓36
24Use of lithium: plasma lithium levels monitored regularlyRoutine data✓37,38
25Percentages of bipolar service users prescribed antidepressants and anxiolyticsRoutine data37,38
26Proportion of patients who are receiving depot antipsychotics who have appropriate laboratory screening testsRoutine data✓25
27Patients have their antipsychotic medication reviewed regularly, considering symptoms and side effects: appropriate referral to specialistRoutine data39,40
28Polypharmacy: reduce number of patients using more than four psychotropic drugs at the same timeRoutine data41
29Monitoring patients with neurological, sexual, sleeping, and sedation side effectsRoutine data42
Mental health assessment and care
30Percentage of patients given annual mental health review by GPRoutine data✓43
31Comprehensive mental status examination and history conducted in patients with a new treatment episodeRoutine data✓25,26
32Referral for specialist mental health assessmentRoutine data37
33Comprehensive assessment of comorbid psychiatric conditions and response to treatmentRoutine data✓25
34Reassess severity of symptomsRoutine data✓44
35Examined for duration of untreated psychosisPrimary data34
36Delayed diagnosisPrimary data45
37Informal carer contactsPrimary data27
38Information on employment statusPrimary data26
Physical health assessment and care
39Diabetes monitoring for people with diabetes and schizophreniaRoutine data✓25
40Diabetes and cholesterol monitoring for people with schizophrenia and diabetesRoutine data✓25
41Diabetes screening for people who are using antipsychotic medicationsRoutine data✓25
42Blood pressure screening for patients with diabetesRoutine data✓✓25,46–49
43Weight management/BMI monitoringRoutine data✓✓25,46–49
44Proportion with increased BMI/abdominal waistlineRoutine data✓✓25,46–49
45Patients with diabetes who received education about diabetes, nutrition, cooking, physical activity, or exerciseRoutine data✓25
46Counselling on physical activity and/or nutrition for those with documented elevated BMIRoutine data✓✓25
47Retinal exam for patients with SMI who have diabetesRoutine data✓25
48Foot exam for patients with SMI who have diabetesRoutine data✓25
49Hypertension counselling: patients with hypertension who received education services related to hypertension, nutrition, cooking, physical activity, or exerciseRoutine data✓25
50Hypertension: recording and monitoring patients with hypertension and high blood cholesterol (LDL)Routine data✓✓25,46–49
51Breast cancer screening for womenRoutine data✓25
52Colorectal cancer screeningRoutine data✓25
53Proportion of patients who have an increased blood pressureRoutine data✓✓25,46–49
54Proportion of patients who have an increased blood glucose levelRoutine data✓✓25
55Proportion of patients who have low levels of glycosylated haemoglobinRoutine data✓✓25
56Proportion of patients who have increased level of blood lipidsRoutine data22
57Comprehensive physical health assessment with appropriate adviceRoutine data✓44
58Patients with diabetes who received psychoeducation related to weight (BMI), diabetes (blood glucose levels)Routine data50
59Medical attention for nephropathyRoutine data51

  • AHRQ = Agency for Healthcare Research and Quality. BMI = body mass index. CPN = community psychiatric nurse. LDL = low-density lipoprotein. QOF = Quality and Outcomes Framework. SMI = serious mental illness.