BACKGROUND/RATIONALE:
The VA treats more than 100,000 people with schizophrenia annually, and this illness accounts for 12% 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. Many individuals with schizophrenia can recover, yet recovery-oriented services are not widely available or utilized at present. Recovery-oriented care requires that patients have access to a range of services that improve outcomes, regular identification of patients who would benefit from specific services, and reorganizing care to ensure that these services are utilized.
OBJECTIVE(S):
EQUIP-2 is a clinic-level controlled trial. From the four participating VISNs, eight specialty mental health programs are enrolled and assigned to care as usual or to receive an intervention supporting the use of a chronic illness care model. Participants are VISN 3: (James J. Peters VA; Northport VA); VISN 16: (Houston VA; Shreveport VA); VISN 17: (Waco VA; Temple VA); and VISN 22: (Long Beach VA; Sepulveda VA). The objectives of this QUERI Service Directed Project are 1) to assist in identifying and making available recovery-oriented services to veterans with schizophrenia; 2) implement information systems that efficiently and accurately identify patient status and who would be appropriate for what service; 3) implement a care model to support recovery-oriented care delivery; 4) evaluate, in a controlled trial, the effect of the informatics systems and care model on treatment delivery and patient outcomes. The project studies intervention feasibility, acceptability, and impact on outcomes; performs qualitative analyses examining processes and variation in care model implementation and impact. 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. Data sources include interviews with participants, implementation documentation, the project informatics system, and VistA.
METHODS:
The care model targets two clinical domains selected by the VISNs from the following: IPS, caregiver support, wellness programs, clozapine, and peer support. All 4 VISNs chose the same two targets---IPS and wellness. The support for the care model includes: 1) routine collection of patient outcomes data by a self-assessment kiosk each time the patient comes to the clinic; 2) provision of these "psychiatric vital signs" to the clinicians at the time of the clinical encounter via report that prints from the kiosk; 3) education and activation of both clinicians and patients around the two clinical targets; 4) regular reports identifying patients appropriate for referral to the services associated with these targets; and 5) problem-solving for any barriers to utilization of these services.
FINDINGS/RESULTS:
No findings at this point; the project is in the early stages of subject enrollment. This project is currently enrolling providers at 7 of the 8 sites and is currently enrolling patients at 2 of the 8 sites. Enrollment at the remaining sites is about to begin.
IMPACT:
This project 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 clinical and research interventions can build upon to improve care, and is designed to inform a national strategy for implementing evidence-based care in schizophrenia. 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.
PUBLICATIONS:
Journal Articles
- Cohen AN, Glynn SM, Murray-Swank AB, Barrio C, Fischer EP, McCutcheon SJ, Perlick DA, Rotondi AJ, Sayers SL, Sherman MD, Dixon LB. The family forum: directions for the implementation of family psychoeducation for severe mental illness. Psychiatric Services. 2008; 59(1): 40-8.
