A Study of Strategies to Improve Schizophrenia Treatment
Condition: Schizophrenia; Schizoaffective Disorder
MeSH terms: Schizophrenia; Psychotic Disorders
Study type: Interventional

Summary: 
      The goal of this project is to translate research findings about key aspects of antipsychotic
      treatment into routine care through a multi-component intervention, focusing on improving two
      aspects of medication management that are directly linked to patient outcomes: 1) monitoring
      for potentially serious metabolic side effects of newer antipsychotic medication, and 2)
      increasing the appropriate use of clozapine for treatment-refractory patients.
    

Detailed description: 
      Background:

      Antipsychotic medication is by far the most widely utilized treatment for schizophrenia in VA
      settings, and the VA has established guidelines for the appropriate use of these medications.
      The recent introduction of a new generation of antipsychotic medications has also offered
      great hope to persons with schizophrenia, but also may adversely affect health due to
      metabolic side effects. Improving all aspects of antipsychotic medication management is
      necessary to improve outcomes for persons with schizophrenia.

      Objectives:

      The goal of this project is to translate research findings about key aspects of antipsychotic
      treatment into routine care through a multi-component intervention. Mental Health QUERI's
      (MHQ) previous project for improving antipsychotic treatment demonstrated that a
      multi-component intervention improved use of guideline-recommended antipsychotic doses. This
      project will build on results and lessons learned from MHQ's previous translation project.
      The scope of translation will be expanded from an ongoing focus on reducing high
      antipsychotic doses to include two additional aspects of medication management that are
      directly linked to patient outcomes: 1) increasing monitoring for potentially serious side
      effects of newer antipsychotic medication, and 2) increasing the appropriate use of clozapine
      for treatment-refractory patients.

      Methods:

      The project is employing a multi-component intervention for improving antipsychotic
      prescribing while comparing the use of two different interpersonal marketing/influence
      strategies for translation. The primary objective is to compare the effectiveness of a
      team-based QI approach and a strategy using a clinical opinion leader augmented by an
      implementation coordinator to improve antipsychotic medication management. In addition, MHQ
      will determine the impact of a support and consultation program to promote clozapine
      prescribing. A total of ten VA Medical Centers from 4 different VA health care networks
      (VISNs) have been selected to participate on the basis of number of patients with
      schizophrenia, baseline performance on quality indicators, and organizational
      characteristics. Six of these sites will focus on side effect monitoring and antipsychotic
      dosing (two team-based QI, two clinical opinion leader, and two control), while two will
      receive the clozapine consultation program, with two matched control sites. Selected
      clinicians and staff (opinion leaders) will be identified and trained, and will implement the
      multi-component intervention consisting of educational materials and programs, information
      system tools, and performance monitoring and feedback. The intervention will take place for 6
      months, and will be assessed with regard to improvement in side effect monitoring, high dose
      antipsychotic prescribing, and clozapine use. In addition, MHQ will assess impact of the
      intervention on patient outcomes at five of the sites.

      Status:

      In partnership with clinical stakeholders, the project team is implementing, adapting and
      evaluating an assortment of clinical tools and training materials designed to improve
      antipsychotic medication management. All, sites, except 1, have completed the intervention.
      All subject recruitment had been completed. The project team is also working with
      participating VAMC IT staff and Clinical Coordinators to fully automate the project's VISTA
      data extraction reoutines and performance monitoring reporting system for local implmentation
      and maintainence
    

Intervention name(s): Team-Based Quality Improvement Intervention; Opinion Leader Intervention; Team Based Quality Improvement
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Intervention to improve recommended dosing and side effect monitoring of antipsychotic medications using a team-based quality improvement effort; Intervention to improve recommended dosing and side effect monitoring of antpsychotic medications using an Opion leader quality improvement effort; Intervention to increase appropriate use of clozapine through a team based quality intervention.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Keywords: schizophrenia; quality of health care; quality indicators; intervention studies