Improving Quality And Diffusing Best Practices: The Case Of Schizophrenia

Western Psychiatric Institute and Clinic, University of Pittsburgh (Pennsylvania) Medical School, USA.
Health Affairs (Impact Factor: 4.97). 05/2009; 28(3):701-12. DOI: 10.1377/hlthaff.28.3.701
Source: PubMed


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.

Full-text preview

Available from:
  • [Show abstract] [Hide abstract]
    ABSTRACT: Police agencies across the country are struggling to respond to significant number of persons with serious mental illness, who are landing on their doorsteps with sometimes tragic consequences. Arguably, the most widely adopted approach, the Crisis Intervention Team (CIT) model, is a specialized police-based program designed to improve officers’ ability to safely and effectively respond to mental health crises. Conducting research on CIT is challenging; thus, the evidence base is limited. In this article, the author reviews the emerging literature, present a conceptual model of CIT effectiveness, and describe a study of CIT in Chicago. Findings from Chicago suggest that CIT is increasing linkage to services and reducing use of force in encounters with persons with mental illness. Lessons learned are discussed.
    Research on Social Work Practice 08/2010; 20(5):536-543. DOI:10.1177/1049731510374201 · 1.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.
    Community Mental Health Journal 07/2012; 49(2). DOI:10.1007/s10597-012-9528-8 · 1.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Antipsychotic drugs (APDs) are best classified as typical or atypical. The distinction is based solely on their ability to cause extrapyramidal side effects (EPS), including tardive dyskinesia (TD). The two classes differ in mechanism of action, with atypical APDs providing important modulation of serotonergic neurotransmission.TDincreases the death rate and can be minimized by limiting use of typical APDs. Clozapine is unique among the atypical APDs in its efficacy for ameliorating psychosis in patients with treatment-resistant schizophrenia (TRS), for reduction of suicide, and for improving longevity. The typical and atypical APDs do not differ in improving psychopathology in non-TRS. The atypicals vary in metabolic side effects: some have little burden. Cognitive benefits of the atypical APDs may be superior for some domains of cognition and require less use of anticholinergic drugs, which impair memory, for treatment of EPS. Overall, choosing among the atypical APDs as firstline treatment represents the best course for schizophrenia and most likely other settings where APDs are used. Expected final online publication date for the Annual Review of Medicine Volume 64 is January 07, 2013. Please see for revised estimates.
    Annual review of medicine 09/2012; 64(1). DOI:10.1146/annurev-med-050911-161504 · 12.93 Impact Factor
Show more