Improving Care and Reducing Cost Study
Condition: Schizophrenia; Schizoaffective Disorder; Psychosis NOS
MeSH terms: Schizophrenia; Psychotic Disorders; Mental Disorders
Study type: Interventional

Summary: 
      The goal of the Improving Care and Reducing Cost (ICRC) Program, is to improve disease
      management and the overall process of care in treating the chronic illness schizophrenia in
      order to reduce ER visits and hospital days while providing better care, better health and
      increased patient satisfaction. This will be done by fostering innovation in the use of
      technology and by training and deploying a new cadre of personnel in the behavioral health
      field: Mental Health/Health Technology (MH/HT) Case Managers.
    

Detailed description: 
      The goal of the Improving Care and Reducing Cost (ICRC) Program, is to improve disease
      management and the overall process of care in treating the chronic illness schizophrenia in
      order to reduce ER visits and hospital days while providing better care, better health and
      increased patient satisfaction. This will be done by fostering innovation in the use of
      technology and by training and deploying a new cadre of personnel in the behavioral health
      field: Mental Health/Health Technology (MH/HT) Case Managers. The specific treatments we
      propose to use are evidence based, but their dissemination has been limited because of lack
      of trained personnel and cost. The model we propose, the Health Technology Program (HTP),
      will address these problems through use of the web and mobile phone based training and
      interventions.

      The components of the HTP program that are being tested in the pilot program include: 1)
      evidence-based pharmacological treatment facilitated by a web-based prescriber decision
      support system-Prescriber Decision Assistant (PDA) 2) brief, in-person, relapse prevention
      counseling with supplemental web-based learning modules, 3) a daily support website that
      offers web- and phone-based resources to support persons with schizophrenia and their family
      members or others. The resources include a patient and family Psycho-Education Treatment
      program, which includes electronic peer groups facilitated by mental health professionals,
      providing medication reminders via web and phone, and conducting monitoring of early warning
      signs of relapse via web and phone 4) an interactive smart phone text-messaging application
      to support medication adherence, facilitate coping with symptoms and improve daily
      functioning in individuals with schizophrenia 5) a web-based, self-administered
      cognitive-behavioral therapy (CBT) program for the management of hallucinations. All patients
      will be provided with pharmacological treatment (PDA), brief in-person relapse prevention
      counseling, and an Android mobile phone. The other program components will be provided to
      patients using a shared decision-making approach to assess need and preference.
    

Intervention name(s): Relapse Prevention Plan; Daily Support Website; Computer CBT for voices and paranoia; FOCUS; Prescriber Decision Assistant
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral; Other
Intervention description(s): brief, in-person, relapse prevention counseling with supplemental web-based learning modules,; web-based program for patients and families that provides psychoeducation about schizophrenia and its treatments to improve knowledge, increase problem-solving skills and offer social support through the use of web-based therapist facilitated sessions; A ten-session CBT programs, one to address voices and the other for paranoia. The web-based programs incorporate the essential elements of CBT for psychosis such as normalizing behavior and offering behavioral coping strategies; an interactive smart phone text-messaging application to support medication adherence, facilitate coping with symptoms and improve daily functioning in individuals with schizophrenia; is a web-based prescriber decision support system that includes a brief patient-completed assessment describing symptoms and adverse events which prompts the prescriber to conduct a detailed clinical assessment. Embedded in the program are decision supports for medication choices based on best evidence-based practices regarding symptoms, side effects, information from laboratory tests and history of prior treatment response
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment