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CPG 97-027 – QUERI Project

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CPG 97-027
A Multi-Site Study of Strategies for Implementing Schizophrenia Guidelines
Richard R. Owen Jr. MD
Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
No. Little Rock, AR
Funding Period: August 1997 - September 2000

BACKGROUND/RATIONALE:
Schizophrenia, a chronic psychiatric disorder, is the second most frequent VA discharge diagnosis. Medication management practices for schizophrenia often are not guideline-concordant and place patients at risk for adverse outcomes. This project tests a new strategy to standard implementation for VHA Schizophrenia Guidelines.

OBJECTIVE(S):
Research objectives are: (1) to compare the effectiveness of a conceptually-based, enhanced intervention to that of a basic educational strategy with regard to improving guideline adherence and patient compliance; (2) to compare the effectiveness of the two strategies with regard to improving symptom and side effect outcomes; (3) to determine the effect of the enhanced intervention on service utilization for acute exacerbations of schizophrenia; (4) to determine the extent to which guideline-concordant medication management improves patient outcomes; and (5) to examine providers' knowledge of and attitudes toward guidelines.

METHODS:
Thirteen VA sites were considered for the study, and VistA data were extracted to assess baseline guideline performance. Seven sites were selected and received basic education about schizophrenia guidelines. Three of these sites were randomly selected to receive the enhanced intervention, employing a nurse coordinator to promote providers' guideline adherence and patients' treatment adherence. Subjects with an acute exacerbation of schizophrenia were enrolled and were interviewed at baseline and six months using the Positive and Negative Syndrome Scale, the Schizophrenia Outcomes Module, and the Barnes Akathisia Scale. Data on guideline adherence were collected from medical records and VistA files. When data collection is completed, analyses will be conducted to determine the effectiveness of the enhanced intervention with regard to improving guideline adherence and patient outcomes.

FINDINGS/RESULTS:
Baseline guideline performance at the seven study sites did not differ from that at the other sites. Overall, 54 percent of patients were prescribed antipsychotic doses within guideline-recommended ranges.

IMPACT:
The project, which extends a decade of research by the research team at the Little Rock HSR&D Center of Excellence, will expand our knowledge of the effectiveness of guideline implementation strategies with regard to improving the process and outcomes of routine care, and altering service utilization patterns. It will also provide information on providers' perceptions of guideline implementation strategies. Findings from this project will be rapidly translated into clinical practice through Mental Health QUERI.

PUBLICATIONS:

Journal Articles

  1. Owen RR, Hudson T, Thrush C, Thapa P, Armitage T, Landes RD. The effectiveness of guideline implementation strategies on improving antipsychotic medication management for schizophrenia. Medical care. 2008 Jul 1; 46(7):686-91.
  2. Hamilton J, Guthrie E, Creed F, Thompson D, Tomenson B, Bennett R, Moriarty K, Stephens W, Liston R. A randomized controlled trial of psychotherapy in patients with chronic functional dyspepsia. Gastroenterology. 2000 Sep 1; 119(3):661-9.
Conference Presentations

  1. Owen RR. Closing the efficacy/effectiveness gap in psychopharmacology: Strategies for implementing schizophrenia guidelines. Paper presented at: American Psychiatric Association Annual Meeting; 2001 May 1; New Orleans, LA.
  2. Hall J, Courville T, Graunke B, Kotria K, Simotas S, Bailey S, Hamilton J. Effect of a Structured Family Education Program on the Use and Cost of Mental Health Services by individuals with Severe Chronic Mental Illness. Paper presented at: American Psychiatric Association Annual Meeting; 2000 Oct 27; Philadelphia, PA.


DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: none
Keywords: Clinical practice guidelines, Schizophrenia
MeSH Terms: Schizophrenia, Guidelines

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