OBJECTIVE: The overall goal of this project is to improve our understanding of patients and their needs, so that the VHA can provide better care. The second goal is to assess dissemination of the care model to a larger group of VHA medical centers with diverse staffing, leadership and norms. We plan to 1) assist VISNs in using evidence based quality improvement to implement and sustain chronic illness care for schizophrenia; 2) evaluate the intervention's impact on patient, provider and organizational outcomes. In a controlled trial, determine the effect of the care model relative to usual care; and 3) study processes of and variations in care model implementation and effectiveness.

METHODS: The study is a multi-site study across 4 VISNs. This study is a clinic-level controlled trial. From the 4 participating VISNs, a total of 8 specialty mental health programs will be chosen. One program from each VISN will be assigned to the intervention and the other will be assigned to care as usual. VISN and medical-center leaders choose the two intervention targets and protocols for implementing those targets are modified to meet local priorities and care structure. Key stakeholders at all sites are interviewed and surveyed about their readiness for change. Patients with schizophrenia and clinic staff are enrolled. At all sites, patients and providers complete a baseline and 9 month follow-up research interview. At intervention sites, providers also complete a mid study interview to inform any needed adjustments to the care model. A central component of the care model is routine, brief assessment of key clinical domains. In order to do this, patients are routinely assessed using computerized selfassessment kiosks. This data is provided to clinicians during the patient's visit, and to managers and staff on a regular basis. Care is targeted at unmet patient needs, using protocols developed for the project. Qualitative and quantitative evaluations of the process of implementation occur pre-mid-and post intervention.

STATUS: Four VISNs are enrolled (3, 16, 17, 22), the eight sites have been chosen and assigned to intervention or control. IRB applications and staff hiring are in progress. Intervention development has commenced in collaboration with project partners.

IMPACT: This project evaluates implementation of a care model to improve treatment for schizophrenia within the context of diverse VA practices and priorities. The project creates a platform that other clinical and research interventions can build upon to improve care, and is designed to inform a national strategy for implementing evidence-based care in schizophrenia. Schizophrenia is a common, disabling illness that has a very high cost to society. In fiscal year 2000, the VA provided care to over 102,000 people with schizophrenia, and 16% of the VA's health care budget was spent on care for people with psychotic disorders.

Principal Investigator:
Alexander S. Young, MD, MSHS; and Amy N. Cohen, PhD.

Partners:
VA Healthcare Centers at Bronx, NY, Northport, NY, Houston, TX, Oklahoma, OK, Waco, TX, Temple, TX, Long Beach, CA, and, Las Vegas, NV.