Table 1. Quality measures of continuity of care for the treatment of schizophrenia.

Measure	Criteria	Guideline-based rationale	Evidence ratinga
Regularity of care
Medication management	≥1 medication management visits with a psychiatrist every 90 days for adults with schizophrenia during a 12 month period	Antipsychotic medications are effective in the treatment of acute exacerbation of schizophrenia but patients need to be seen on a regular basis by a physician to monitor changes in symptoms and adverse side effects	C
Availability of outpatient treatment	≥1 outpatient visits every 90 days for adults with schizophrenia during a 12 month period	As a minimal standard of care, periodic outpatient visits by a mental health practitioner are necessary for patients with schizophrenia to prevent relapse	C
Transitions of care
Intensity of aftercare	≥1 outpatient visit per month for 180 day period after discharge from psychiatric hospital for adults with schizophrenia	Timely and appropriate aftercare is necessary, particularly during the first few months after discharge to prevent readmission, relapse, and suicidal behavior	B
Care coordination
Case management	≥1 visit by a case manager every 90 days for adults with schizophrenia or schizoaffective disorder who had ≥2 hospitalizations or ≥4 emergency room visits during a 12 month period	Intensive case management, particularly assertive community treatment, has been shown to be effective in reducing psychiatric hospitalizations for high users	A
Substance abuse or dependence treatment	≥4 outpatient psychiatric visits and 4 substance abuse visits for adults diagnosed with schizophrenia and substance-related disorder	Comorbid substance abuse is common among schizophrenia patients and associated with a number of negative outcomes. Research studies have found that providing appropriate treatment for both conditions is associated with an increased likelihood of abstinence, improved psychiatric outcomes, and lower likelihood of hospitalization	B
Treatment engagement
	Adult who had a psychiatric evaluation or new exacerbation of schizophrenia had a second outpatient mental health visit within 14–90 days	Research has shown that 30–50 % of individuals with severe mental illness fail to attend scheduled outpatient visits. After the initial psychiatric evaluation, patients should be seen frequently	C

Source for criteria: Hermann et al. (2002)

^aAHRQ rating categories were used to assess the research evidence: A good research evidence, B fair research evidence, C no research evidence, clinical consensus or opinion that good continuity of care would prevent emergency room use and hospitalization