Systematic Quality Improvement and Metabolic Monitoring for Individuals Taking Antipsychotic Drugs.

OBJECTIVE: The authors sought to increase the rate of cardiometabolic monitoring for patients receiving antipsychotic drugs in an academic outpatient psychiatric clinic serving people with serious mental illness. METHODS: Using a prospective quasi-experimental, interrupted time-series design with data from the electronic health record (EHR), the authors determined metabolic monitoring rates before, during, and after implementation of prespecified quality improvement (QI) measures between August 2016 and July 2017. QI measures included a combination of provider, patient, and staff education; systematic barrier reduction; and an EHR-based reminder system. RESULTS: After 1 year of QI implementation, the rate of metabolic monitoring had increased from 33% to 49% (p<0.01) for the primary outcome measure (hemoglobin A1C and lipid panel). This increased monitoring rate was sustained for 27 months beyond the end of the QI intervention. More than 75% of providers did not find the QI reminders burdensome. CONCLUSIONS: Significant improvement in the rate of metabolic monitoring for people taking antipsychotic drugs can be achieved with little added burden on providers. Future research needs to assess the full range of patient, provider, and system barriers that prevent cardiometabolic monitoring for all individuals receiving antipsychotic drugs.

Traumatic Brain Injury in Iraq and Afghanistan Veterans: New Results From a National Random Sample Study.

This study randomly sampled post-9/11 military veterans and reports on causes, predictors, and frequency of traumatic brain injury (TBI) (N=1,388). A total of 17.3% met criteria for TBI during military service, with about one-half reporting multiple head injuries, which were related to higher rates of posttraumatic stress disorder, depression, back pain, and suicidal ideation. The most common mechanisms of TBI included blasts (33.1%), objects hitting head (31.7%), and fall (13.5%). TBI was associated with enlisted rank, male gender, high combat exposure, and sustaining TBI prior to military service. Clinical and research efforts in veterans should consider TBI mechanism, effects of cumulative TBI, and screening for premilitary TBI.