Schizophrenia is a common, disabling illness that has a very high cost to society. In fiscal year 2000, the VA provided care to over 102,000 people with schizophrenia, and 16% of the VA’s health care budget was spent on care for people with psychotic disorders. Effective care for schizophrenia requires evaluating a patient’s needs, and then selecting and ensuring delivery of appropriate treatments from a number of domains. Unfortunately, a large proportion of patients do not receive appropriate care and outcomes in usual practices are much worse than in state-of-the-art care. Common problems in care include inadequate clinical assessment, poor communication among the treatment team, lack of caregiver involvement, and failure to deliver care assertively. Too often, treatments are not matched well with patients’ needs.

Condition	Intervention
Schizophrenic Disorder Chronic Illness Schizoaffective Disorder Weight Gain Psychotic Disorder	Procedure: Collaborative Chronic Illness Care Model

Further Study Details: 

Primary Outcomes: At 9 months, evaluate the effect of care model implementation on provider competencies, treatment appropriateness, patient outcomes and service utilization
Secondary Outcomes: Evaluate processes of and variations in care model implementation and effectiveness to strengthen the intervention and to assess acceptability, how strategies affect implementation and the impact of individual components on treatment appropriateness
Expected Total Enrollment:  1040

Background:

Schizophrenia is a common, disabling illness that has a very high cost to society. In fiscal year 2000, the VA provided care to over 102,000 people with schizophrenia, and 16% of the VA’s health care budget was spent on care for people with psychotic disorders. Effective care for schizophrenia requires evaluating a patient’s needs, and then selecting and ensuring delivery of appropriate treatments from a number of domains. Unfortunately, a large proportion of patients do not receive appropriate care and outcomes in usual practices are much worse than in state-of-the-art care. Common problems in care include inadequate clinical assessment, poor communication among the treatment team, lack of caregiver involvement, and failure to deliver care assertively. Too often, treatments are not matched well with patients’ needs.

Objectives:

The goal of this QUERI Service Directed Project (SDP) is to implement evidence-based treatment for schizophrenia into VA practice. This SDP is a partnership between the Mental Health QUERI and the Mental Illness Research, Education and Clinical Centers (MIRECCs) of VISNs 16, 20 and 22. It builds on the successful VA EQUIP project, which has demonstrated the feasibility and usefulness of a collaborative care model for schizophrenia. The collaborative care model focuses on improving three domains of care for this chronic illness: 1) providing assertive care to severely ill patients; 2) educating and activating caregivers; and 3) ensuring that treatment and rehabilitation respond appropriately to patients’ symptoms, side-effects, and functional impairments. A central component of the care model is routine, brief assessment of key clinical domains. An informatics system provides these psychiatric “vital signs” to clinicians during the patient encounter and facilitates communication among team-members. Reports are generated that identify problems in care for each patient. Clinicians and managers use these reports to enhance access to necessary treatments. Quality coordinators proactively identify and address gaps in care, and ensure collaboration among clinicians, the patient and caregivers.

Methods:

Will use an evidence-based quality improvement strategy to implement collaborative care for schizophrenia at mental health clinics in three VISNs. Study intervention feasibility, acceptability, and impact on outcomes. Perform qualitative analyses examining processes and variation in care model implementation and impact. The project team partners with leadership of the VISNs to adapt methods from EQUIP to local circumstances and to implement collaborative care at mental health clinics. Research includes a controlled trial of the impact of collaborative care, relative to usual care, on treatment quality. Participants include clinic staff and patients with schizophrenia. A process evaluation describes factors related to model acceptability, implementation, and impact. Data sources include interviews with participants, implementation documentation, the project informatics system, and VistA.

Findings:

None at this time.

Status:

Not yet funded.

Impact:

This SDP evaluates implementation of a care model to improve treatment for schizophrenia within the context of diverse VA practices and priorities. The project creates a platform that other interventions can build upon to improve care, and is designed to inform a national strategy for implementing evidence-based care in schizophrenia.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

Providers (Psychiatrists, Case Managers, Nurses):

Working at one of the participating VA Medical Centers

Patients:

• At least 18 years old
• Diagnosis of Schizophrenia, Schizoaffective, or schizophreniform disorder
• At least 2 treatment visits with a psychiatrist at the clinic during the previous 6 months.

Exclusion Criteria:

None

Please refer to this study by ClinicalTrials.gov identifier  NCT00137280

California
      VA Greater Los Angeles Health Care System, Los Angeles,  California,  90073,  United States

Study chairs or principal investigators

Alexander S. Young, MD MSHS,  Principal Investigator,  VA Greater Los Angeles Health Care System   

Study ID Numbers:  MNT 03-213; MH 068639
Last Updated:  August 26, 2005
Record first received:  August 25, 2005
ClinicalTrials.gov Identifier:  NCT00137280
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-08-30