Assessment of cognitive impairment, treatment adherence, and healthcare resource utilization among treated schizophrenia patients

Document Type

Conference Proceeding

Publication Date


Publication Title

Schizophr Bull


Background: Cognitive impairment associated with schizophrenia (CIAS) is common and can impact health outcomes (1). Information on the use of cognitive testing in clinical practice is lacking, and the relationship between cognitive impairment and healthcare resource utilization (HCRU) is poorly understood. This study assessed the measurement of CIAS and the associa-tion between CIAS, treatment adherence, and HCRU.

Methods: Claims data from the Henry Ford Health System, a vertically integrated healthcare system serving metropolitan Detroit, Michigan, were used to identify patients aged 18 to 64 years with schizophrenia and use of antipsychotics from January 01, 2009, to June 30, 2014. Patients had ≥12 months of continuous enrollment preindex and ≥6 months postindex. The index date was the date of frst diagnosis of schizophrenia. Patients with cognitive decline independent of CIAS or schizoaf-fective disorder were excluded. Electronic medical records (EMR) were used to confrm diagnosis of schizophrenia and to assess measures of CIAS. Due to the lack of standardized measures of CIAS, 2 independent expert reviewers assessed mental status exam (MSE) records for evidence of CIAS and classifed patients as “clearly impaired” or “not impaired” during the assessment period. Administrative claims were used to assess treatment adherence during the study period and HCRU in the 12 months following index among patients with ≥12 months of follow-up. Descriptive statistics were performed as the study was exploratory in nature.

Results: Following application of the inclusion/exclusion criteria and EMR assessment, 65 subjects were confrmed schizophrenia patients. The sample was 59% male with average age at index date of 43 years; 22% of patients were white, 62% black, and the remaining were unclassifed. Only 8% of patients had evidence of a standardized cognitive assessment. However, all patients had ≥1 MSE records; 60% (N = 39) of patients were classifed with CIAS through MSE review. The average medication possession ratio (MPR) for antipsychotic medica-tions was 0.4 ± 0.3 for cognitively impaired patients (N = 29) and 0.6 ± 0.4 for nonimpaired patients (N = 25). CIAS patients had 0.5 ± 0.4 outpatient visits, 0.08 ± 0.0 hospitalizations, and 0.15 ± 0.08 emergency department visits per patient per month (PPPM), whereas nonimpaired patients had 0.7 ± 0.7, 0 ± 0.0, and 0.08 ± 0.0 visits, respectively.

Conclusion: Although cognitive impairment is prevalent in schizophrenia patients, the results suggest that CIAS is not formally assessed in clinical practice. Additional research is needed to understand the relationship between CIAS, HCRU, and outcomes.



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