Evaluating a Collaborative Care Model for the Treatment of Schizophrenia (EQUIP)

NCT00119574 | Completed

• 4 other identifiers: CPI 99-383RCD 00-033NIMH MH-5423NIMH MH-068639
• Study Type: interventional
• Target: 443
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Schizophrenia Disorders; Chronic Illness; Schizoaffective Disorder; Weight Gain

Keywords

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

Outcome Measures

Primary Outcomes (1)

• At 15 mo.: Provider attitudes on controlling symptoms & side-effects, & on family involvement Patient clinical outcomes Throughout the study: Patient compliance Provider practice patterns & adherence to VA guidelines Patient utilization

Secondary Outcomes (1)

• Process assessment throughout the course of the study of barriers and facilitators to the intervention�s implementation

Study Arms (1)

Arm 1

OTHER

Procedure: Collaborative Chronic Illness Model

Interventions

Collaborative Chronic Illness Model PROCEDURE

Arm 1

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Providers (Psychiatrists, Case Managers, Nurses):
• Working at one of the participating VA Mental Health Clinics
• Providers: 68 Patients: 375
• 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.

You may not qualify if:

• None

Sponsors & Collaborators

• US Department of Veterans Affairs: lead
• University of California, Los Angeles: collaborator
• asd: collaborator

Study Sites (1)

VA Greater Los Angeles Healthcare System, West Los Angeles, CA

West Los Angeles, California, 90073, United States

Location

Related Publications (6)

• Niv N, Cohen AN, Sullivan G, Young AS. The MIRECC version of the Global Assessment of Functioning scale: reliability and validity. Psychiatr Serv. 2007 Apr;58(4):529-35. doi: 10.1176/ps.2007.58.4.529.

  PMID: 17412856 RESULT

• Niv N, Cohen AN, Mintz J, Ventura J, Young AS. The validity of using patient self-report to assess psychotic symptoms in schizophrenia. Schizophr Res. 2007 Feb;90(1-3):245-50. doi: 10.1016/j.schres.2006.11.011. Epub 2007 Jan 3.

  PMID: 17204397 RESULT

• Glynn SM, Cohen AN, Niv N. New challenges in family interventions for schizophrenia. Expert Rev Neurother. 2007 Jan;7(1):33-43. doi: 10.1586/14737175.7.1.33.

  PMID: 17187495 RESULT

• Erhart SM, Young AS, Marder SR, Mintz J. Clinical utility of magnetic resonance imaging radiographs for suspected organic syndromes in adult psychiatry. J Clin Psychiatry. 2005 Aug;66(8):968-73. doi: 10.4088/jcp.v66n0802.

  PMID: 16086610 RESULT

• Young AS, Mintz J, Cohen AN, Chinman MJ. A network-based system to improve care for schizophrenia: the Medical Informatics Network Tool (MINT). J Am Med Inform Assoc. 2004 Sep-Oct;11(5):358-67. doi: 10.1197/jamia.M1492. Epub 2004 Jun 7.

  PMID: 15187072 RESULT

• Young AS, Mintz J, Cohen AN. Using information systems to improve care for persons with schizophrenia. Psychiatr Serv. 2004 Mar;55(3):253-5. doi: 10.1176/appi.ps.55.3.253. No abstract available.

  PMID: 15001724 RESULT

Related Links

• Tour of the Medical Informatics Tool (MINT) which was developed and utilized to support the intervention

MeSH Terms

Conditions

Schizophrenia; Chronic Disease; Psychotic Disorders; Weight Gain; Psychological Well-Being

Condition Hierarchy (Ancestors)

Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Body Weight Changes; Body Weight; Signs and Symptoms; Personal Satisfaction; Behavior

Study Officials

• Alexander Stehle Young, MD MSHS

  VA Greater Los Angeles Healthcare System, West Los Angeles, CA

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: FACTORIAL
• Sponsor Type: FED
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 1, 2005
• First Posted: July 13, 2005
• Study Start: January 1, 2002
• Study Completion: December 1, 2004
• Last Updated: April 7, 2015

Record last verified: 2005-07

Locations

US (1)