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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

1002 — Evaluating a Chronic Care Model Designed to Improve Treatment for Schizophrenia (EQUIP)

Author List:

The VA treats more than 100,000 people with schizophrenia annually, and this illness accounts for 11.7 percent of all VA healthcare costs. Outcomes in schizophrenia are good when appropriate medication and psychosocial treatments are received, however, rates of appropriate care nationally are moderate to low. The President’s New Freedom Commission established national goals for improving mental health care, and the VA has committed to implementing evidence-based and recovery-oriented care. This places the VA in a leadership position nationally, but also creates challenges since there has been relatively little research on implementation of best practices in schizophrenia. This project ("EQUIP") applied principles of chronic illness care to schizophrenia, and evaluated their effectiveness in a controlled trial.

Psychiatrists at two VA medical centers were randomized to continue with usual care or to receive an intervention that included routine management of patient outcomes data, and protocols for assertive, coordinated care and evidence-based medication and family services. Patients were routinely assessed, and an informatics system provided these "psychiatric vital signs" to psychiatrists during the patient visit. Regular feedback to clinicians and managers facilitated reorganization of care. Patients and clinicians were interviewed at baseline and follow-up, and utilization data obtained from VistA. A summative evaluation examined the effect of the intervention on providers and treatment quality. Analyses included repeated measures regression. A process evaluation studied the organization of care, and barriers and facilitators to implementation.

68 psychiatrists and 375 patients participated, and the intervention was implemented for more than 15 months. Psychiatrists stated that they learned important new information and that team communication improved. The intervention resulted in more assertive medical and mental health care. Rates of poor care for psychosis improved significantly more under the intervention (73% to 70% vs 71% to 88%; p=.03). Wellness groups were established, improving the management of side-effects and weight. The intervention did not improve the use of clozapine or caregiver services.

Previously, it has not generally been possible to manage the quality of care for schizophrenia. EQUIP established an infrastructure to manage care quality, produced improvement in certain care domains, and identified barriers to further improving care.

This project informs efforts to improve chronic illness care, and especially schizophrenia.

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