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Normand SLT, Zelevinsky K, Abing HK, Horvitz-Lennon M. Statistical Approaches for Quantifying the Quality of Neurosurgical Care. World Neurosurg 2022; 161:331-342.e1. [PMID: 35505552 PMCID: PMC9074098 DOI: 10.1016/j.wneu.2022.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Quantifying quality of health care can provide valuable information to patients, providers, and policy makers. However, the observational nature of measuring quality complicates assessments. METHODS We describe a conceptual model for defining quality and its implications about the data collected, how to make inferences about quality, and the assumptions required to provide statistically valid estimates. Twenty-one binary or polytomous quality measures collected from 101,051 adult Medicaid beneficiaries aged 18-64 years with schizophrenia from 5 U.S. states show methodology. A categorical principal components analysis establishes dimensionality of quality, and item response theory models characterize the relationship between each quality measure and a unidimensional quality construct. Latent regression models estimate racial/ethnic and geographic quality disparities. RESULTS More than 90% of beneficiaries filled at least 1 antipsychotic prescription and 19% were hospitalized for schizophrenia during a 12-month observational period in our multistate cohort with approximately 2/3 nonwhite beneficiaries. Four quality constructs emerged: inpatient, emergency room, pharmacologic/ambulatory, and ambulatory only. Using a 2-parameter logistic model, pharmacologic/ambulatory care quality varied from -2.35 to 1.26 (higher = better quality). Black and Latinx beneficiaries had lower pharmacologic/ambulatory quality compared with whites. Race/ethnicity modified the association of state and pharmacologic/ambulatory care quality in latent regression modeling. Average quality ranged from -0.28 (95% confidence interval, -2.15 to 1.04) for blacks in New Jersey to 0.46 [95% confidence interval, -0.89 to 1.40] for whites in Michigan. CONCLUSIONS By combining multiple quality measures using item response theory models, a composite measure can be estimated that has more statistical power to detect differences among subjects than the observed mean per subject.
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Affiliation(s)
- Sharon-Lise T Normand
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Department of Biostatistics, Harvard Chan School of Public Health, Boston, Massachusetts, USA.
| | - Katya Zelevinsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Haley K Abing
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcela Horvitz-Lennon
- RAND Corporation, Boston, Massachusetts, USA; Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Hert MD, Hudyana H, Dockx L, Bernagie C, Sweers K, Tack J, Leucht S, Peuskens J. Second-generation antipsychotics and constipation: A review of the literature. Eur Psychiatry 2020; 26:34-44. [DOI: 10.1016/j.eurpsy.2010.03.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/27/2010] [Accepted: 03/04/2010] [Indexed: 01/01/2023] Open
Abstract
AbstractAntipsychotics are the cornerstone in the management of psychotic disorders and schizophrenia. They are effective agents but also have a wide range of side effects. In the recent literature constipation as possible side effect has received little attention. A review of the literature concerning constipation associated with antipsychotics was performed. Overall constipation is a rarely studied or reported side effect of antipsychotic medication. Nevertheless constipation is a common side effect. Antipsychotic agents differ in their liability to induce constipation. Constipation can be severe and can lead to serious consequences such as paralytic ileus, bowel occlusion and death. Active screening, monitoring and treatment are recommended. Further research on incidence, prevalence, underlying mechanisms and preventive measures is required.
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Shimada T, Ohori M, Inagaki Y, Shimooka Y, Sugimura N, Ishihara I, Yoshida T, Kobayashi M. A multicenter, randomized controlled trial of individualized occupational therapy for patients with schizophrenia in Japan. PLoS One 2018; 13:e0193869. [PMID: 29621261 PMCID: PMC5886394 DOI: 10.1371/journal.pone.0193869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/16/2018] [Indexed: 11/18/2022] Open
Abstract
The individualized occupational therapy (IOT) program is a psychosocial program that we developed to facilitate proactive participation in treatment and improve cognitive functioning and other outcomes for inpatients with acute schizophrenia. The program consists of motivational interviewing, self-monitoring, individualized visits, handicraft activities, individualized psychoeducation, and discharge planning. This multicenter, open-labeled, blinded-endpoint, randomized controlled trial evaluated the impact of adding IOT to a group OT (GOT) program as usual for outcomes in recently hospitalized patients with schizophrenia in Japanese psychiatric hospitals setting compared with GOT alone. Patients with schizophrenia were randomly assigned to the GOT+IOT group or the GOT alone group. Among 136 randomized patients, 129 were included in the intent-to-treat population: 66 in the GOT+IOT and 63 in the GOT alone groups. Outcomes were administered at baseline and discharge or 3 months following hospitalization including the Brief Assessment of Cognition in Schizophrenia Japanese version (BACS-J), the Schizophrenia Cognition Rating Scale Japanese version, the Social Functioning Scale Japanese version, the Global Assessment of Functioning scale, the Intrinsic Motivation Inventory Japanese version (IMI-J), the Morisky Medication Adherence Scale-8 (MMAS-8), the Positive and Negative Syndrome Scale (PANSS), and the Japanese version of Client Satisfaction Questionnaire-8 (CSQ-8J). Results of linear mixed effects models indicated that the IOT+GOT showed significant improvements in verbal memory (p <0.01), working memory (p = 0.02), verbal fluency (p < 0.01), attention (p < 0.01), and composite score (p < 0.01) on the BACS-J; interest/enjoyment (p < 0.01), value/usefulness (p < 0.01), perceived choice (p < 0.01), and IMI-J total (p < 0.01) on the IMI-J; MMAS-8 score (p < 0.01) compared with the GOT alone. Patients in the GOT+IOT demonstrated significant improvements on the CSQ-8J compared with the GOT alone (p < 0.01). The present findings provide support for the feasibility in implementing an IOT program and its effectiveness for improving cognitive impairment and other outcomes in patients with schizophrenia.
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Affiliation(s)
- Takeshi Shimada
- Department of Occupational Therapy, Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
| | - Manami Ohori
- Department of Occupational Therapy, North Alps Medical Center, Azumi Hospital, Nagano, Japan
| | - Yusuke Inagaki
- Department of Occupational Therapy, Nagano Prefectural Mental Wellness Center Komagane, Nagano, Japan
| | - Yuko Shimooka
- Department of Occupational Therapy, Social Medical Corporation Ritsuzankai, Iida Hospital, Nagano, Japan
| | - Naoya Sugimura
- Department of Occupational Therapy, Medical Corporation Akitsukai, Nanshin Hospital, Nagano, Japan
| | - Ikuyo Ishihara
- Department of Occupational Therapy, Medical Corporation Aiseikai, Matsuoka Hospital, Nagano, Japan
| | - Tomotaka Yoshida
- Department of Occupational Therapy, Medical Corporation Seitaikai, Mental Support Soyokaze Hospital, Nagano, Japan
| | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan
- * E-mail:
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van Fenema E, Giltay E, van Noorden M, van Hemert A, Zitman F. Assessing adherence to guidelines with administrative data in psychiatric outpatients. J Eval Clin Pract 2017. [PMID: 26223425 DOI: 10.1111/jep.12414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES To assess (feasibility) of adherence to treatment guidelines among outpatients with common mental disorders in a routine Dutch clinical outpatient setting for common mental disorders using administrative data. METHODS In a retrospective cohort study, we analysed routinely collected administrative data of 5346 patients, treated for mood, anxiety or somatoform disorders with pharmacotherapy, psychotherapy or a combination of both. Available administrative data allowed assessment of guideline adherence with a disorder-independent set of five quality indicators, assessing psychotherapy, pharmacotherapy, a combination of both and routine outcome measurements (ROM) during diagnostic and therapeutic phases. Associations between the socio-demographic variables age, gender, clinical diagnosis and treatment type on the one hand and non-adherence to guidelines were tested using logistic regression analysis. RESULTS Patients were aged 39.5 years (SD 13.0) on average. The majority of patients were treated with a combination of pharmacotherapy and psychotherapy (50.1%), followed by psychotherapy (44.2%) and pharmacotherapy (5.6%). The majority of patients were suffering from a mood disorder (50.0%), followed by anxiety (43.9%) and somatoform disorders (6.1%). A diagnosis of anxiety or somatoform disorder was associated with higher odds of suboptimal duration [odds ratio (OR): 1.55 and 1.82[ and suboptimal frequency of psychotherapeutic treatment (OR of 0.89 and 0.63), and absence of ROM in the diagnostic phase (ORs 1.31 and 1.36, respectively) compared with depressive disorders. No ROM in the diagnostic phase was also predicted for by increasing age (ORs for the age categories of 56 and older of 1.48). CONCLUSIONS In this proof of principal study, we were able to assess some key indicators assessing adherence to clinical guidelines by using administrative data. Also, we could identify predictors of adherence with simple parameters available in every administrative data. Administrative data could help to monitor and aid guideline adherence in routine care, although quality may vary between settings.
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Affiliation(s)
- Esther van Fenema
- Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik Giltay
- Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Albert van Hemert
- Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Frans Zitman
- Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Fontanella CA, Guada J, Phillips G, Ranbom L, Fortney JC. Individual and contextual-level factors associated with continuity of care for adults with schizophrenia. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:572-87. [PMID: 23689992 DOI: 10.1007/s10488-013-0500-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18-64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care.
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Affiliation(s)
- Cynthia A Fontanella
- Department of Psychiatry, The Ohio State University, 1670 Upham Drive, Columbus, OH, 43210, USA,
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Shaner R, Thompson KS, Braslow J, Ragins M, Parks JJ, Vaccaro JV. How Health Reform is Recasting Public Psychiatry. Psychiatr Clin North Am 2015; 38:543-57. [PMID: 26300038 DOI: 10.1016/j.psc.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article reviews the fiscal, programmatic, clinical, and cultural forces of health care reform that are transforming the work of public psychiatrists. Areas of rapid change and issues of concern are discussed. A proposed health care reform agenda for public psychiatric leadership emphasizes (1) access to quality mental health care, (2) promotion of recovery practices in primary care, (3) promotion of public psychiatry values within general psychiatry, (4) engagement in national policy formulation and implementation, and (5) further development of psychiatric leadership focused on public and community mental health.
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Affiliation(s)
- Roderick Shaner
- Los Angeles County Department of Mental Health, Keck School of Medicine, University of Southern California, 550 South Vermont Avenue, 12th Floor, Los Angeles, CA 90020, USA.
| | - Kenneth S Thompson
- Pennsylvania Psychiatric Leadership Council, 6108 Kentucky Avenue, Pittsburgh, PA 15206, USA
| | - Joel Braslow
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Box 951759, CHS 33-251, Los Angeles, CA 90095-1759, USA; Department of History, UCLA Wilshire Center, University of California, Los Angeles, Suite 300, 10920 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Mark Ragins
- MHA Village Integrated Service Agency, 456 Elm Avenue, Long Beach, CA 90802, USA
| | - Joseph John Parks
- Missouri Institute of Mental Health, University of Missouri-St. Louis, Dome Building, 5400 Arsenal, St Louis, MO 63139, USA
| | - Jerome V Vaccaro
- Right Path HC, Ingenuity Health, 10 Fox Den Road, Mounts Kisco, NY 10549, USA
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Jørgensen M, Mainz J, Svendsen ML, Nordentoft M, Voldsgaard I, Baandrup L, Bartels P, Johnsen SP. Improving quality of care among patients hospitalised with schizophrenia: a nationwide initiative. BJPsych Open 2015; 1:48-53. [PMID: 27703722 PMCID: PMC4998939 DOI: 10.1192/bjpo.bp.115.000406] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/10/2015] [Accepted: 06/30/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The effectiveness of systematic quality improvement initiatives in psychiatric care remains unclear. AIMS To examine whether quality of care has changed following implementation of a systematic monitoring programme of hospital performance measures. METHOD In a nationwide population-based cohort study, we identified 14 228 patients admitted to psychiatric departments between 2004 and 2011 from The Danish Schizophrenia Registry. The registry systematically monitors the adherence to guideline recommended processes of care. RESULTS The overall proportion of all relevant recommended processes of care increased from 64 to 76% between 2004 and 2011. The adherence to individual processes of care increased over time, including assessment of psychopathology using a diagnostic interview (relative risk (RR): 2.01, 95% CI: 1.51-2.68), contact with relatives (RR: 1.44, 95% CI: 1.27-1.62), psychoeducation (RR: 1.33, 95% CI: 1.19-1.48), psychiatric aftercare (RR: 1.06, 95% CI: 1.01-1.11) and suicide risk assessment (RR: 1.31, 95% CI: 1.21-1.42). CONCLUSIONS Quality of care improved from 2004 to 2011 among patients hospitalised with schizophrenia in Denmark. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
| | - Jan Mainz
- , MD, PhD, Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - Marie Louise Svendsen
- , MHSc, PhD, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Merete Nordentoft
- , MD, PhD, Psychiatric Centre Copenhagen, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Inge Voldsgaard
- , Chief nurse, RN, MNSc, MPG, Psychosis Ward, Section P. Aarhus University Hospital, Risskov, Denmark
| | - Lone Baandrup
- , MD, PhD, Center for Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Paul Bartels
- , Medical Director, Danish Clinical Registries, Aarhus N, Denmark
| | - Søren Paaske Johnsen
- , MD, PhD, Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Horvitz-Lennon M, Volya R, Donohue JM, Lave JR, Stein BD, Normand SLT. Disparities in quality of care among publicly insured adults with schizophrenia in four large U.S. states, 2002-2008. Health Serv Res 2014; 49:1121-44. [PMID: 24628414 DOI: 10.1111/1475-6773.12162] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine racial/ethnic disparities in quality of schizophrenia care and assess the size of observed disparities across states and over time. DATA SOURCES Medicaid claims data from CA, FL, NY, and NC. STUDY DESIGN Observational repeated cross-sectional panel cohort study of white, black, and Latino fee-for-service adult beneficiaries with schizophrenia. Main outcome was the relationship of race/ethnicity and year with a composite measure of quality of schizophrenia care derived from 14 evidence-based quality indicators. PRINCIPAL FINDINGS Quality was assessed for 325,373 twelve-month person-episodes between 2002 and 2008, corresponding to 123,496 Medicaid beneficiaries. In 2002, quality was lowest for blacks in all states. With the exception of FL, quality was lower for Latinos than whites. In CA, blacks had about 43 percent of the individual indicators met compared to 58 percent for whites. Quality improved annually for all groups in CA, NY, and NC. While in CA the improvement was slightly larger for Latinos, in FL quality improved for blacks but declined for Latinos and whites. CONCLUSIONS Quality of schizophrenia care is poor and racial/ethnic disparities exist among Medicaid beneficiaries from four states. The size of the disparities varied across the states, and most of the initial disparities were unchanged by 2008.
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Addington D, McKenzie E, Smith H, Chuang H, Boucher S, Adams B, Ismail Z. Conformance to evidence-based treatment recommendations in schizophrenia treatment services. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:317-23. [PMID: 22546064 DOI: 10.1177/070674371205700507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess quality of health care provided in a representative Canadian mental health service using conformance to evidence-based treatment recommendations, and to examine differences from published US results. METHOD We used a cross-sectional cohort design involving a randomly selected sample of patients diagnosed with schizophrenia attending 1 of 3 mental health clinics in 1 Canadian regional health system. The sample size was calculated to detect differences with the US sample. Conformance criteria were based on a published protocol. Data were collected using patient interviews and a structured review of health records. Conformance to 9 key Schizophrenia Patient Outcomes Research Team recommendations was assessed. RESULTS Conformance ranged between 58% and 90% for pharmacological recommendations, and 0% to 81% for psychosocial recommendations. No patients who met criteria for assertive case management had been referred to an assertive case management team. Significant differences in conformance rates to some treatment recommendations were found between Canadian and published US results. CONCLUSIONS It proved possible to assess health care quality using process measures of conformance to treatment recommendations. Conformance to clinical recommendations for pharmacotherapy is higher than for psychosocial therapies. The absence of barriers to access for pharmacological therapies likely enhances the higher conformance to these recommendations. Limited or variable access to psychosocial services, specifically assertive community treatment, likely negatively affects conformance to psychosocial treatment recommendations. Methodological limitations preclude drawing conclusions on comparisons between Canadian and US services.
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Affiliation(s)
- Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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Robst J. Changes in antipsychotic medication use after implementation of a Medicaid mental health carve-out in the US. PHARMACOECONOMICS 2012; 30:387-396. [PMID: 22316397 DOI: 10.2165/11539830-000000000-00000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Many Medicaid programmes now offer behavioural healthcare through managed care organizations. Medicaid programmes are concerned about carve-outs because the use of non-included services may rise, limiting the efficiencies anticipated with the implementation of managed care. There also exist concerns that patients with serious mental illness may receive reduced care through managed care and consequently have poorer outcomes. OBJECTIVE This study examined prescription drug utilization among Medicaid recipients with the implementation of a mental health carve-out plan in Florida. In particular, this study examined short-run changes in the utilization of antipsychotic medications among individuals diagnosed with schizophrenia or episodic mood disorders with the implementation of Prepaid Mental Health Plans (PMHPs) in Florida Medicaid. METHODS This study used Medicaid data from 38 counties in Florida that implemented the PMHP programme in 2005 and 2006. The sample was limited to individuals aged≤64 years who were continuously enrolled in Medicaid. Individuals were required to have at least two diagnoses of schizophrenia, episodic mood disorders, delusional disorders or other nonorganic disorders (three-digit International Classification of Diseases, Ninth Revision [ICD-9] code of 295-298). Five different outcome measures were examined on a monthly basis for the 6 months pre- and post-PMHP implementation: penetration; adherence; Medicaid expenditures for antipsychotics; polypharmacy (multiple antipsychotic medications); and whether dosing was within guidelines. Generalized estimating equations were used to estimate associations between individual and insurance characteristics, and the outcome variables. The analyses were conducted using SAS procedure GENMOD. Empirical (robust) standard errors were calculated to account for repeated observations on the same individual. RESULTS There were 153,720 monthly observations for the 12,810 people in the sample. Seventy-four percent of the sample was aged between 21 and 54 years, while 65% were female, 30% White, 14% Black and 44% Hispanic. The large proportion of Hispanics stems from the introduction of the PMHP programme in Dade County (Miami). The results indicate the implementation of the PMHP was associated with increased penetration, but reduced adherence, polypharmacy and expenditures by the Medicaid agency. There was no change in the likelihood of prescriptions being written within recommended dosage ranges. CONCLUSION The introduction of the PMHP was associated with short-run changes in medication utilization among individuals with serious mental illness.
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Affiliation(s)
- John Robst
- Department of Mental Health Law and Policy, University of South Florida, Tampa, FL 33612, USA.
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Assessing adherence to guidelines for common mental disorders in routine clinical practice. Int J Qual Health Care 2011; 24:72-9. [DOI: 10.1093/intqhc/mzr076] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kreyenbuhl J, Buchanan RW, Dickerson FB, Dixon LB. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2009. Schizophr Bull 2010; 36:94-103. [PMID: 19955388 PMCID: PMC2800150 DOI: 10.1093/schbul/sbp130] [Citation(s) in RCA: 345] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Schizophrenia Patient Outcomes Research Team (PORT) project has played a significant role in the development and dissemination of evidence-based practices for schizophrenia. In contrast to other clinical guidelines, the Schizophrenia PORT Treatment Recommendations, initially published in 1998 and first revised in 2003, are based primarily on empirical data. Over the last 5 years, research on psychopharmacologic and psychosocial treatments for schizophrenia has continued to evolve, warranting an update of the PORT recommendations. In consultation with expert advisors, 2 Evidence Review Groups (ERGs) identified 41 treatment areas for review and conducted electronic literature searches to identify all clinical studies published since the last PORT literature review. The ERGs also reviewed studies preceding 2002 in areas not covered by previous PORT reviews, including smoking cessation, substance abuse, and weight loss. The ERGs reviewed over 600 studies and synthesized the research evidence, producing recommendations for those treatments for which the evidence was sufficiently strong to merit recommendation status. For those treatments lacking empirical support, the ERGs produced parallel summary statements. An Expert Panel consisting of 39 schizophrenia researchers, clinicians, and consumers attended a conference in November 2008 in which consensus was reached on the state of the evidence for each of the treatment areas reviewed. The methods and outcomes of the update process are presented here and resulted in recommendations for 16 psychopharmacologic and 8 psychosocial treatments for schizophrenia. Another 13 psychopharmacologic and 4 psychosocial treatments had insufficient evidence to support a recommendation, representing significant unmet needs in important treatment domains.
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Affiliation(s)
- Julie Kreyenbuhl
- VA Capitol Health care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA.
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | | | - Lisa B. Dixon
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 West Lombard Street, 5th Floor, Baltimore, MD 21201,VA Capitol Health care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, MD
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Teixeira-Pinto A, Normand SLT. Correlated bivariate continuous and binary outcomes: issues and applications. Stat Med 2009; 28:1753-73. [PMID: 19358234 DOI: 10.1002/sim.3588] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Increasingly multiple outcomes are collected in order to characterize treatment effectiveness or to evaluate the impact of large policy initiatives. Often the multiple outcomes are non-commensurate, e.g. measured on different scales. The common approach to inference is to model each outcome separately ignoring the potential correlation among the responses. We describe and contrast several full likelihood and quasi-likelihood multivariate methods for non-commensurate outcomes. We present a new multivariate model to analyze binary and continuous correlated outcomes using a latent variable. We study the efficiency gains of the multivariate methods relative to the univariate approach. For complete data, all approaches yield consistent parameter estimates. When the mean structure of all outcomes depends on the same set of covariates, efficiency gains by adopting a multivariate approach are negligible. In contrast, when the mean outcomes depend on different covariate sets, large efficiency gains are realized. Three real examples illustrate the different approaches.
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Affiliation(s)
- Armando Teixeira-Pinto
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, University of Porto, Porto, Portugal.
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Mojtabai R, Fochtmann L, Chang SW, Kotov R, Craig TJ, Bromet E. Unmet need for mental health care in schizophrenia: an overview of literature and new data from a first-admission study. Schizophr Bull 2009; 35:679-95. [PMID: 19505994 PMCID: PMC2696378 DOI: 10.1093/schbul/sbp045] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We present an overview of the literature on the patterns of mental health service use and the unmet need for care in individuals with schizophrenia with a focus on studies in the United States. We also present new data on the longitudinal course of treatments from a study of first-admission patients with schizophrenia. In epidemiological surveys, approximately 40% of the respondents with schizophrenia report that they have not received any mental health treatments in the preceding 6-12 months. Clinical epidemiological studies also find that many patients virtually drop out of treatment after their index contact with services and receive little mental health care in subsequent years. Clinical studies of patients in routine treatment settings indicate that the treatment patterns of these patients often fall short of the benchmarks set by evidence-based practice guidelines, while at least half of these patients continue to experience significant symptoms. The divergence from the guidelines is more pronounced with regard to psychosocial than medication treatments and in outpatient than in inpatient settings. The expansion of managed care has led to further reduction in the use of psychosocial treatments and, in some settings, continuity of care. In conclusion, we found a substantial level of unmet need for care among individuals with schizophrenia both at community level and in treatment settings. More than half of the individuals with this often chronic and disabling condition receive either no treatment or suboptimal treatment. Recovery in this patient population cannot be fully achieved without enhancing access to services and improving the quality of available services. The recent expansion of managed care has made this goal more difficult to achieve.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Laura Fochtmann
- Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, NY
| | - Su-Wei Chang
- Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, NY
| | - Roman Kotov
- Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, NY
| | | | - Evelyn Bromet
- Department of Psychiatry and Behavioral Sciences, State University of New York, Stony Brook, NY
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Horvitz-Lennon M, Donohue JM, Domino ME, Normand SLT. Improving quality and diffusing best practices: the case of schizophrenia. Health Aff (Millwood) 2009; 28:701-12. [PMID: 19414878 PMCID: PMC2832306 DOI: 10.1377/hlthaff.28.3.701] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The slow spread of treatments supported by empirical evidence and the rapid diffusion of treatments lacking such support play major roles in the lower quality of mental health care received by people with severe mental illnesses compared with the care of less severely ill people. Further, the rapid spread of treatments that are of low cost-effectiveness limits the system's ability to provide the full gamut of high-value treatments available to treat this vulnerable population. Using the case of schizophrenia, we review the context in which these paradoxical patterns of diffusion have occurred, and we propose policy solutions.
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Affiliation(s)
- Marcela Horvitz-Lennon
- University of Pittsburgh School of Medicine 201 North Craig St., office 250 Pittsburgh, PA 15213 Tel: (412) 383.5121 Fax: (412) 383.5121
| | - Julie M. Donohue
- Department of Health Policy and Management University of Pittsburgh Graduate School of Public Health Crabtree Hall A613, 130 DeSoto St. Pittsburgh, PA 15261 Tel: (412) 624.4562 Fax: (412) 624.3146
| | - Marisa E. Domino
- Department of Health Policy and Administration University of North Carolina 1104G McGavran-Greenberg Hall, CB#7411 Chapel Hill, NC 27599 Tel: (919) 966.3891 Fax: (919) 966.6961
| | - Sharon-Lise T. Normand
- Department of Health Care Policy, Harvard Medical School Department of Biostatistics, Harvard School of Public Health 180 Longwood Ave. Boston, MA 02115 Tel: (617) 432.3260 Fax: (617) 432.2563
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16
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Stiles PG, Boothroyd RA, Dhont K, Beiler PF, Green AE. Adherence to practice guidelines, clinical outcomes, and costs among Medicaid enrollees with severe mental illnesses. Eval Health Prof 2009; 32:69-89. [PMID: 19164300 DOI: 10.1177/0163278708328744] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The treatment of Medicaid enrollees diagnosed with depression or schizophrenia was examined to determine whether adherence to treatment guideline was associated with health care financing strategy, clinical outcomes, and cost-effectiveness. Individuals in a fee-for-service condition were significantly more likely to receive treatment consistent with guidelines than those in managed care. Mental health costs were higher for individuals diagnosed with schizophrenia, individuals in an acute phase of illness at intake into the study, and those receiving treatment consistent with practice guidelines. Being in an acute phase of illness and having treatment that comported with recommended practice guidelines were associated with higher total social costs. Policy implications of the findings and recommendations for future research are discussed.
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Affiliation(s)
- Paul G Stiles
- Louis de la Parte Florida Mental Health Institute, Tampa, FL 33612, USA.
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17
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Abstract
Several reports have described the poor quality of care delivered to psychotic patients. However, the context in which care was delivered, including the structure, organization, and performance of the health care system, as a possible determinant of quality of care has received less attention. In this study we explored the relationship between conformance with guidelines and structural and organizational characteristics in 2 departments of Mental Health in Italy. Dosing of antipsychotic drugs in the maintenance phase was investigated in 125 patients. Higher than recommended doses could be explained by the high patient caseload per psychiatrist, leading to insufficient contacts with patients and their families and to excessive reliance upon drug treatment. The analysis of structural and organizational determinants of care at the local level may help to explain insufficient quality and to plan suitable interventions.
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18
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Taylor PJ. Psychosis and violence: stories, fears, and reality. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:647-59. [PMID: 18940033 DOI: 10.1177/070674370805301004] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals with psychosis are often feared. In fact, they are themselves likely to be victims of violence; however, the main aim of this review is to provide an overview of the evidence on relations between psychosis and violence to others. The terms psychosis and violence were used in a literature search limited to the Cochrane Library and PubMed, a manual search of 8 journals, and a follow-up of additional references in the articles found. The overview draws on new empirical data and major reviews. Almost all sound epidemiologic data on psychosis and violence dates from 1990. There is consistency on a small but significant relation between schizophrenia and violent acts. Since then there has also been movement toward understanding the nature of associations and progress on strategies for managing individuals who have psychosis and are violent. Public fears about individuals with psychotic illnesses are largely unfounded, although there would be benefit in greater attention to the safety of those in their close social circle. The task for the next 10 years must be the development and application of knowledge to improve specific treatments-that is, interventions that go beyond holding and caring to bring about substantial change.
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Affiliation(s)
- Pamela J Taylor
- Forensic Psychiatry, School of Medicine, Cardiff University, Cardiff, Wales.
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19
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Lass J, Männik A, Bell JS. Pharmacotherapy of first episode psychosis in Estonia: comparison with national and international treatment guidelines. J Clin Pharm Ther 2008; 33:165-73. [PMID: 18315782 DOI: 10.1111/j.1365-2710.2008.00900.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The pharmacotherapy of psychosis often differs between countries and with respect to treatment guidelines. Little is known about the treatment of first episode psychosis in countries of the former Soviet Union. The objective of the study was to analyse and describe the pharmacotherapy of first episode psychosis in Estonia. METHODS Case notes for consecutive patients with schizophrenia, schizotypal or delusional disorders admitted to the psychiatry clinics of the North Estonia Regional Hospital (NERH) and Tartu University Hospital (TUH) between September 2005 and September 2006 were retrospectively reviewed by a trained researcher. Treatment regimens were assessed according to prescribed doses, the incidence of antipsychotic polypharmacy and prescribing of conventional vs. atypical agents. RESULTS There were 234 patients admitted to the NERH and TUH, 142 of which were included in the final analyses (mean age 30.3 years for males, 40.4 years for females). Patients were most frequently treated with risperidone (n = 94), olanzapine (n = 43), chlorpromazine (n = 31), haloperidol (n = 21) and quetiapine (n = 24). Fourteen patients received concurrent treatment with two or more antipsychotics for three or more treatment days. Nine patients received antipsychotics in doses exceeding the maximum recommended doses in the British National Formulary. CONCLUSIONS The pharmacotherapy of first episode psychosis in Estonia was largely consistent with Estonian and international guidelines, however, the use of conventional antipsychotics and antipsychotic polypharmacy remained common. Estonian treatment guidelines may need to be revised to reflect the best available research evidence.
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Affiliation(s)
- J Lass
- Pharmacy Department, Tartu University Hospital, Tartu, Estonia.
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20
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Portela MC, Lima SML, Ferreira VMB, Escosteguy CC, Brito C, Vasconcellos MTLD. [Clinical guidelines and other practices for improving quality of care by health plans from the perspective of their operators in Brazil]. CAD SAUDE PUBLICA 2008; 24:253-66. [PMID: 18278272 DOI: 10.1590/s0102-311x2008000200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 07/24/2007] [Indexed: 11/21/2022] Open
Abstract
This study aimed to characterize the implementation of clinical guidelines and other instruments and practices for health care quality improvement among health plan operators in Brazil. It was a national cross-sectional descriptive study, initially considering 1,573 health plan operators registered in the National Agency for Supplementary Health Care. The sample design was complex, stratified by macro-region, market segment, and number of beneficiaries. Ninety health plan operators agreed to participate and were interviewed. To obtain estimates for the universe of health plan operators, a sample expansion factor attributed per stratum was considered. Only 32.3% of the health plan operators implemented clinical guidelines, with important variation across regions and market segments. Clinical governance practices are still in the very initial stages. Challenges are presented with regard to health care incorporation as a dimension of management within health care organizations, including health plan operators. Initiatives to improve quality of care need to be integrated and conducted at the organizational level.
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21
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Assessment, Authorization and Access to Medicaid Managed Mental Health Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 34:548-62. [DOI: 10.1007/s10488-007-0138-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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22
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Abstract
When clinical psychologists make judgments, are they likely to be correct or incorrect? The following topics are reviewed: (a) methodological advances in evaluating the validity of descriptions of personality and psychopathology, (b) recent findings on the cognitive processes of clinicians, and (c) the validity of judgments and utility of decisions made by mental health professionals. Results from research on clinical judgment and decision making and their relationship to conflicts within the field of clinical psychology are discussed.
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Affiliation(s)
- Howard N Garb
- Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas 78236-5300, USA.
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23
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Tzeng DS, Lian LC, Chang CU, Yang CY, Lee GT, Pan P, Lung FW. Healthcare in schizophrenia: effectiveness and progress of a redesigned care network. BMC Health Serv Res 2007; 7:129. [PMID: 17705853 PMCID: PMC2000889 DOI: 10.1186/1472-6963-7-129] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 08/17/2007] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was designed to investigate the care-effectiveness of different healthcare models for schizophrenic patients and the impact of it on caregivers. Methods Sample cases were randomly selected from southern Taiwan, 257 patients in redesigned care network, including a general hospital, a chronic ward, 10 outpatient clinics, and multialternative community programs, was compared to 247 patients in other traditional healthcare provider that were utilized as the control group. The quality of life (QOL) questionnaire and the Chinese health questionnaire (CHQ) were used. Results The controls had longer duration of illness (p = 0.001) and were older (p = 0.004). The average resource utilization in the study group (US$ 2737/year, per case) was higher than the control group (US$ 2041) (t = 7.91, p < 0.001). For the study group, the average length of stay was shorter, but the admission rate was higher. The QOL of the patients in the study group was better than that of the controls (p = 0.01). The family burden of the study group was lower (p = 0.035) and the score of general health questionnaire higher (p = 0.019). Conclusion We found that patients in the redesigned care network had a better QOL, lower family burden, decreased days of hospital stay, higher medical resource utilization and less frequent admission to a hospital, and the caregivers had better mental health. Although the costs were higher, the continued care network was more helpful in providing comprehensive mental illness services.
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Affiliation(s)
- Dong-Sheng Tzeng
- Department of Psychiatry, Military Kaohsiung General Hospital, Kaohsiung, Taiwan
- Graduate Institute of Occupational Safety and Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Chiu Lian
- National Health Insurance, Kao-Pin Department, Taiwan
| | - Chin-Un Chang
- National Health Insurance, Kao-Pin Department, Taiwan
| | - Chun-Yuh Yang
- College of Alliance Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gian-Tin Lee
- National Health Insurance, Kao-Pin Department, Taiwan
| | - Peter Pan
- Calo Psychiatric Center, Pingdong County, Taiwan
| | - For-Wey Lung
- Department of Psychiatry, Military Kaohsiung General Hospital, Kaohsiung, Taiwan
- Calo Psychiatric Center, Pingdong County, Taiwan
- Graduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
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24
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Hermann RC, Rollins CK, Chan JA. Risk-adjusting outcomes of mental health and substance-related care: a review of the literature. Harv Rev Psychiatry 2007; 15:52-69. [PMID: 17454175 DOI: 10.1080/10673220701307596] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Risk adjustment is increasingly recognized as crucial to refining health care reimbursement and to comparing provider performance in terms of quality and outcomes of care. Risk adjustment for mental and substance use conditions has lagged behind other areas of medicine, but model development specific to these conditions has accelerated in recent years. After describing outcomes of mental health and substance-related care and associated risk factors, we review research studies on risk adjustment meeting the following criteria: (1) publication in a peer-reviewed journal between 1980 and 2002, (2) evaluation of one or more multivariate models used to risk-adjust comparisons of utilization, cost, or clinical outcomes of mental or substance use conditions across providers, and (3) quantitative assessment of the proportion of variance explained by patient characteristics in the model (e.g., R(2) or c-statistic). We identified 36 articles that included 72 models addressing utilization, 74 models of expenditures, and 15 models of clinical outcomes. Models based on diagnostic and sociodemographic information available from administrative data sets explained an average 6.7% of variance, whereas models using more detailed sources of data explained a more robust 22.8%. Results are appraised in the context of the mental health care system's needs for risk adjustment; we assess what has been accomplished, where gaps remain, and directions for future development.
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Affiliation(s)
- Richard C Hermann
- The Center for Organization, Leadership and Management Research. Veterans Health Administration, Boston, MA, USA.
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25
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Chavez LM, Canino G, Shrout PE, Barrio C, Ware NC. Psychometric evaluation of the Spanish version of CONNECT: a measure of continuity of care in mental health services. Int J Methods Psychiatr Res 2007; 16:23-33. [PMID: 17425245 PMCID: PMC6878412 DOI: 10.1002/mpr.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This article provides the results of the psychometric testing of the Spanish version of CONNECT(-S), a measure of continuity of care in mental health services. CONNECT-S is a multidimensional measure designed for use with seriously mentally ill respondents. Consisting of 12 scales and one single-item indicator, it addresses qualities of interaction in current relationships between mental health service providers and consumers in five conceptual domains: (1) practitioner knowledge of their clients, (2) creating flexibility, (3) practitioner availability, (4) practitioner co-ordination, and (5) smoothing transitions. One-hundred-and-fifty participants took part in the study. Participants were recruited from mental health outpatient clinics in both the Puerto Rican (n = 109) and the San Antonio (n = 41) samples. Internal consistency for scales in a combined site estimate ranged from 0.68 to 0.96. Test-retest reliability ranged from fair to substantial in all but one scale. Concurrent validity hypotheses based on a priori predictions were mostly supported. The Spanish translation and adaptation of CONNECT-S provided sound psychometric results across both sites. CONNECT-S addresses the gap in measurement of continuity of care for the two largest US Latino subgroups, Mexican Americans and Puerto Ricans; and provides an encouraging starting point for a measure that is both relevant and culturally sensitive.
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Affiliation(s)
- L M Chavez
- Behavioral Sciences Research Institute and the Department of Pediatrics, University of Puerto Rico, Puerto Rico, San Juan.
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26
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Busch AB, Frank RG, Lehman AF, Greenfield SF. Schizophrenia, co-occurring substance use disorders and quality of care: the differential effect of a managed behavioral health care carve-out. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2006; 33:388-97. [PMID: 16755397 PMCID: PMC2084476 DOI: 10.1007/s10488-006-0045-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study explores the differential effect of a managed behavioral health Carve-Out (CO) on outpatient treatment quality for persons with schizophrenia (SCHZ) alone and co-occurring substance use disorders (SUD) (SCHZ+SUD). We used claims data from a state Medicaid program and employed a retrospective, quasi-experimental design with logit and difference in difference formula regression models. The results show the CO was associated with greater changes in treatment quality for the SCHZ population, compared to the SCHZ+SUD population. Most pronounced across both populations were decrements in receiving the psychosocial treatments for enrollees in the CO arrangement.
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Affiliation(s)
- Alisa B Busch
- Alcohol and Drug Abuse Treatment Program and the Department of Health Care Policy, McLean Hospital and Harvard Medical School, Proctor Building, 115 Mill St, Belmont, MA 02446, USA.
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27
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Bianconi JM, Mahler JM, McFarland BH. Outcomes for rural Medicaid clients with severe mental illness in fee for service versus managed care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2006; 33:411-22. [PMID: 16607575 DOI: 10.1007/s10488-006-0041-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
This study compared outcomes for rural Medicaid clients with severe mental illness in fee for service versus managed care programs. Interviews were conducted with 305 Medicaid clients in rural Oregon (166 in fee for service and 139 in managed care). Logistic and multivariate regression analyses were used to examine client satisfaction, safety, symptoms, functioning, and family satisfaction in the fee for service versus managed care groups. There was no evidence that conversion of the Medicaid mental health system from fee for service to managed care led to changes in outcomes for rural clients with severe mental illness.
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Affiliation(s)
- Jacqueline M Bianconi
- Department of Psychaitry, Oregon Health & Science University, Portland, OR 97239, USA.
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28
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Martínez Granados F, Moñino Martínez C, Pol Yanguas E, Ivorra Cano JM, Villar Malpica JL. Análisis de la correlación entre la calidad de la prescripción de antipsicóticos y el estado clínico en pacientes con esquizofrenia. FARMACIA HOSPITALARIA 2005; 29:95-103. [PMID: 16013931 DOI: 10.1016/s1130-6343(05)73644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to describe the psychopharmacological aspects of psychiatric practice in a group of schizophrenic patients and to evaluate whether or not practice agrees with treatment guidelines. The study also intends to objectively measure the psychopathological state of patients in order to establish correlation between different pharmacological aspects of treatment and their clinical outcomes. METHOD We have elaborated six recommendations concerning the pharmacological treatment of schizophrenia, taken from several guides, which are based on evidence. The psychopathological state of patients has been evaluated with the Brief Psychiatric Rating Scale (BPRS) and real prescription practice has been analysed. BPRS rates are compared depending on compliance with guidelines. RESULTS More than 60% of patients do not comply with at least 4 of 6 evidence-based recommendations; compliance with recommendations being associated with a minor BPRS punctuation. Differences in BPRS punctuation between compliant and not compliant groups for 3 recommendations (maintenance antipsychotic dosage, antipsychotic association and drugs with a negative effect on cognitive functions), are statistically significant(p < 0,05; bilateral). DISCUSSION Medical practice which closely follows treatment guidelines results in satisfactory clinical outcomes.
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Affiliation(s)
- F Martínez Granados
- Unidad de Hospitalización Psiquiátrica y Centro SocioAsistencial Dr. Esquerdo, San Juan, Spain
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29
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Eisen SV, Normand SL, Belanger AJ, Spiro A, Esch D. The Revised Behavior and Symptom Identification Scale (BASIS-R). Med Care 2004; 42:1230-41. [PMID: 15550803 DOI: 10.1097/00005650-200412000-00010] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To assess outcomes of health services, providers need brief, responsive, reliable, and valid measures that can be implemented in clinical settings with minimal cost and burden. The Behavior and Symptom Identification Scale (BASIS-32) is a self-report measure developed in 1984 to assess mental health treatment outcomes. During the past 3 years, multiple methods were used to revise the instrument to improve reliability, validity, and applicability to diverse groups of mental health service recipients. OBJECTIVE The objective of this study was to field test the revised instrument, make further changes based on analysis of the field test data, and assess reliability and validity of the final version (BASIS-24). METHODS A field test was implemented at 27 treatment sites across the United States. A total of 2656 inpatients and 3222 outpatients participated. Factor analytic methods, classic test theory, and item response theory modeling were used to select the most discriminating, nonredundant items for inclusion in the final version of the instrument and to assess its reliability and validity. Item response theory modeling was used to score the instrument. RESULTS The final instrument includes 24 items assessing 6 domains: depression/ functioning, interpersonal relationships, self-harm, emotional lability, psychosis, and substance abuse. Test-retest and internal consistency reliability were acceptable. Tests of construct and discriminant validity supported the instrument's ability to discriminate groups expected to differ in mental health status, and its correlation with other measures of mental health. CONCLUSIONS Analyses of the BASIS-24 supported its reliability and validity for assessing mental health status from the patient's perspective.
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Affiliation(s)
- Susan V Eisen
- Center for Health Quality Outcomes and Economics Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
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30
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Gotham HJ. Diffusion of Mental Health and Substance Abuse Treatments: Development Dissemination, and Implementation. ACTA ACUST UNITED AC 2004. [DOI: 10.1093/clipsy.bph067] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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