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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3050 — Effects of Guideline-Implementation Strategies on Service Utilization for Schizophrenia Patients

Author List:
Armitage TL (VA HSR&D Center for Mental Healthcare and Outcomes Research (CeMHOR) and University of Arkansas for Medical Sciences (UAMS))
Thrush CR (CeMHOR/UAMS)
Owen RR (CeMHOR/UAMS)
Hudson TJ (CeMHOR/UAMS)
Williams DK (CeMHOR/UAMS)
Thapa PT (CeMHOR/UAMS)

Objectives:
The purpose of this study was to examine use of acute and routine mental health services for patients with schizophrenia who received care at basic guideline implementation sites compared to those who received care at intervention sites, which received a conceptually driven, multi-component strategy for implementing schizophrenia guidelines.

Methods:
Patients included in the study were recruited from six VAMCs within 3 VHA networks. One VAMC within each network was randomly selected to receive an enhanced intervention that employed a nurse coordinator to promote providers' adherence to guidelines and patients' treatment adherence, creating a matched site-pair within each VISN. Inpatient and outpatient service utilization during the 6-month period after patient enrollment was analyzed for 349 patients, comparing those receiving the intervention to those who did not and controlling for patient covariates. Use of any emergency room and inpatient services were modeled by logistic regression. Poisson regression techniques were used to model number of inpatient days and routine outpatient visits. Due to large variation between VISNs, each site-pair was analyzed separately.

Results:
No significant differences were found between basic and enhanced implementation sites with regard to inpatient use or number of inpatient days within any of the three site-pairs (mean number of inpatient days for all basic sites=9.1; enhanced=8.3). Significantly greater emergency room usage was found at the basic site within one site-pair (OR 3.97; 95% CI 1.06 – 14.85; p = 0.0409). The effects of the intervention on routine outpatient visits were statistically significant within two of the three site-pairs controlling for patient covariates (p = 0.0006; p < 0.0001).

Implications:
The results suggest that while the intervention was not significantly associated with a decrease in inpatient service use, it was associated with a decrease in acute emergency room service use and increases in routine outpatient contact.

Impacts:
A multi-component-guideline implementation strategy may help improve patient adherence to appointments and maintenance of an ongoing patient-system relationship and may reduce the use of acute ER visits by patients with schizophrenia. This type of intervention is consistent with the VA priority to improve quality of care in schizophrenia through development and implementation of clinical practice guidelines.


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