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Sponsors and Collaborators: |
Department of Veterans Affairs NIMH UCLA-RAND Research Center on Managed Care for Psychiatric Disorder NIMH UCLA-RAND Center for Research on Quality in Managed Care |
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Information provided by: | Department of Veterans Affairs |
ClinicalTrials.gov Identifier: | NCT00119574 |
Policy makers and consumers are increasingly concerned about the quality and efficiency of care provided to individuals with severe, chronic illnesses such as schizophrenia. These illnesses are expensive to treat and present significant challenges to organizations that are responsible for providing effective care. Occurring in 1% of the United States population, schizophrenia accounts for 10% of permanently disabled people, and 2.5% of all healthcare expenditures. Clinical practice guidelines have been promulgated. Schizophrenia is treatable and outcomes can be substantially improved with the appropriate use of antipsychotic medication, caregiver education and counseling, vocational rehabilitation, and assertive treatment. However, in the VA and other mental health systems, many patients with schizophrenia receive substandard care. Methods are needed that improve the quality of usual care for this disorder while being feasible to implement at typical clinics.
To date, most efforts to improve care for schizophrenia have focused on educating clinicians or changing the financing of care, and have had limited success. We believe a more fundamental approach should be tried. While there are many potential strategies, experience in chronic medical illness and mental health support the efficacy of specific approaches. Collaborative care models are one such approach. They are a blueprint for reorganizing practice, and involve changes in division of labor and responsibility, adoption of new care protocols, and increased attention to patients' needs. Although collaborative care models have been successful in other chronic medical conditions, they have not yet been studied in the treatment of schizophrenia.
We have developed a collaborative care model for schizophrenia that builds on work in other disorders, and includes service delivery approaches that are known to be effective in schizophrenia. The model focuses on improving treatment through assertive care management, caregiver education and support, and standardized patient assessment with feedback of information to psychiatrists. This project, "EQUIP" (Enhancing Quality Utilization In Psychosis) is implementing collaborative care and evaluating its effectiveness in schizophrenia.
Condition | Intervention |
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Schizophrenia Disorders Chronic Illness Schizoaffective Disorder Weight Gain |
Procedure: Collaborative Chronic Illness Model |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Open Label, Active Control, Factorial Assignment, Safety/Efficacy Study |
Official Title: | Evaluating a Collaborative Care Model for the Treatment of Schizophrenia (EQUIP) |
Estimated Enrollment: | 443 |
Study Start Date: | January 2002 |
Study Completion Date: | December 2004 |
Arms | Assigned Interventions |
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1 | Procedure: Collaborative Chronic Illness Model |
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Providers (Psychiatrists, Case Managers, Nurses):
Working at one of the participating VA Mental Health Clinics
Providers: 68 Patients: 375
Patients:
Exclusion Criteria:
None
United States, California | |
VA Greater Los Angeles Health Care System | |
Los Angeles, California, United States, 90073 |
Principal Investigator: | Alexander S. Young, MD MSHS | VA Greater Los Angeles Health Care System |
Responsible Party: | Department of Veterans Affairs ( Young, Alexander - Principal Investigator ) |
Study ID Numbers: | CPI 99-383, RCD 00-033, NIMH MH-5423, NIMH MH-068639 |
Study First Received: | July 1, 2005 |
Last Updated: | October 31, 2008 |
ClinicalTrials.gov Identifier: | NCT00119574 |
Health Authority: | United States: Federal Government |
Randomized Controlled Trial Quality of Health Care Health Services Research Guidelines Medical Informatics Computing |
Services, Mental Health Medicine, Evidence-Based Quality Assurance, Healthcare Quality Indicators, Health Care Veterans |
Schizophrenia Body Weight Signs and Symptoms Mental Disorders Body Weight Changes |
Psychotic Disorders Chronic Disease Weight Gain Schizophrenia and Disorders with Psychotic Features |
Disease Attributes Pathologic Processes Disease |