From PORT to Policy to Patient Outcomes: Crossing the Quality Chasm

New York State Psychiatric Institute, Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 12/2009; 36(1):109-11. DOI: 10.1093/schbul/sbp142
Source: PubMed
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Available from: Harold Alan Pincus
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    • "There are many reasons for the disconnection between science and practice; among these a lack of funding and confused lines of authority and organization for planning, budgeting, prioritizing, and implementing services are prominent. The consequences of organizational disarray include lack of access to skilled mentoring and monitoring, inadequate training, inadequate assessment, uncoordinated planning, and lack of financial provisions [63, 64]. Government policies and the manner in which they are implemented often support practices that foster institutional care and incarceration, rather than providing incentives and support for the implementation of comprehensive programs community-based treatment programs. "
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    ABSTRACT: Empirically validated psychosocial therapies for individuals diagnosed with schizophrenia were described in the report of the Schizophrenia Patient Outcomes Research Team (PORT, 2009). The PORT team identified eight psychosocial treatments: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. PORT listings of empirically validated psychosocial therapies provide a useful template for the design of effective recovery-oriented mental health care systems. Unfortunately, surveys indicate that PORT listings have not been implemented in clinical settings. Obstacles to the implementation of PORT psychosocial therapy listings and suggestions for changes needed to foster implementation are discussed. Limitations of PORT therapy listings that are based on therapy outcome efficacy studies are discussed, and cross-cultural and course and outcome studies of correlates of recovery are summarized.
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    • "Thus, from this evidence it seems that, regardless of the published guidelines, medical care involving blood tests (and to a lesser extent clinical tests such as blood pressure and weight monitoring) is often overlooked. Extensive research shows that in many areas guidelines are difficult to implement and so it should come as no surprise that the improvement following the introduction of guidelines is only modest (Pincus 2010). As few as one-third of medical patients receive guideline-concordant, evidence-based care (Grol 2001). "
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    ABSTRACT: There is clear evidence of increased medical comorbidity and related mortality in people with severe mental illness, despite numerous guidelines for managing medical conditions in this population. This article assesses inequalities in medical treatment and preventive healthcare received by psychiatric patients compared with the general population. It considers whether the medical care provided is adequate and whether published guidelines improve it. Mental health specialists, general practitioners and hospital specialists appear to deliver poorer than average medical care for this vulnerable population. Implementation of physical healthcare guidelines is incomplete and the guidelines must be matched with resources to address this deficit.
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