Objective: A large Veterans Integrated Service Network (VISN16) mandated in October 2003 metabolic monitoring prior to initiation of any antipsychotic. This study focused on schizophrenia patients who were initiated at VISN 16 on any atypical antipsychotic, and compared patient characteristics and resource utilization of patients who have undergone metabolic monitoring versus those who have not. Methods: We used VISN16 electronic medical records data for October 2002-August 2005 to identify schizophrenia patients who were initiated on any atypical antipsychotic. Patients who have undergone metabolic monitoring in the 180 days prior to medication initiation (MetMon+) were compared to patients who did not (MetMon-), on patient characteristics and resource utilization in the 1-year prior to medication initiation. Logistic regression was used to identify predictors of undergoing metabolic monitoring. Results: Most patients (3568 of 4709, or 75.8%) have undergone metabolic monitoring. Compared to the MetMon- group, the MetMon+ patients were more likely to be overweight or obese (40.8% vs. 19.4%, p<0.001), were more likely to be hospitalized in the prior year (49.6% vs. 31.5%, p<0.001), had a higher Charlson Comorbidity Index score (0.67 versus 0.46 p<0.001), a higher rate of substance use disorders (45.3% vs. 35.8% p<0.001), more office visits (23.5 vs. 15.9, p<0.001), a longer duration of antipsychotic use (208.7 days vs. 160.0 days p<0.001), a higher medication possession ratio (59% vs. 47% p<0.001), and a larger number of different antipsychotic drugs (1.6 vs. 1.5, p<0.001). The logistic regression model confirmed differences in patient characteristics and utilization patterns. Conclusion: A majority of the VISN 16 schizophrenia patients have undergone metabolic monitoring prior to initiation of atypical antipsychotics. Compared to patients who did not undergo metabolic monitoring, those who did were more likely to be overweight or obese and manifest a more severe illness profile.