EQUIP: Implementing chronic care principles and applying formative evaluation methods to improve care for schizophrenia: QUERI Series

Brown, Amira K.; Cohen, Amy N.; Chinman, Matthew; Kessler, Christopher; Young, Alexander S.

doi:10.1186/1748-5908-3-9

Cited by 43 publications

(39 citation statements)

References 32 publications

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“…As summarized in Table 4, the Hybrid Type 2 “Enhancing Quality and Utilization in Psychosis study” 31 was an 8-site VA study where 4 sites were randomized to a chronic illness care model for schizophrenia (clinical/delivery system intervention) supported by an implementation strategy (facilitation, quality improvement teams, quality reports, etc.). The study gathered clinical and implementation outcome data at all sites.…”

Section: Hybrid Designs: Conceptual Developmentmentioning

confidence: 99%

Effectiveness-implementation Hybrid Designs

et al. 2012

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Objectives This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a “hybrid effectiveness-implementation” typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. Results An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention’s impact on relevant outcomes. Conclusions The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.

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Section: Hybrid Designs: Conceptual Developmentmentioning

confidence: 99%

Effectiveness-implementation Hybrid Designs

et al. 2012

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“…Specifically the strategy included routine collection of data from patient-facing kiosks, data continuously provided to clinicians and administrators, utilization of clinical champions to discuss these data and their relationship to benchmarks, clinician education, automated patient education, social marketing of the EQUIP Wellness Program, and evidence-based quality improvement multidisciplinary teams at each implementation site, some of which worked on barriers to utilization of weight management services. 35 …”

Section: Methodsmentioning

confidence: 99%

“…This design balances attention to the effectiveness of the clinical intervention and the implementation strategy that supports the intervention. 34,35 EQUIP evaluated effectiveness and implementation of evidence-based care for schizophrenia at specialty mental health clinics in the Veterans Health Administration (VHA). The clinical interventions of interest were Supported Employment and psychosocial interventions for weight management; this paper focuses on the latter.…”

Section: Introductionmentioning

confidence: 99%

Using Patient-facing Kiosks to Support Quality Improvement at Mental Health Clinics

Cohen¹,

Chinman²,

Hamilton³

et al. 2013

Medical Care

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Objectives Evidence-based services improve outcomes in schizophrenia, but most patients at mental health clinics do not receive such services. This gap in care has been perpetuated by a lack of routinely collected data on patients’ clinical status and the treatments they receive. However, routine data collection can be completed by patients themselves, especially when aided by health information technology (HIT). It is not known whether these data can be used to improve care quality. Methods In a controlled trial, eight medical centers of the Veterans Health Administration were assigned to implementation or usual care. 571 patients with schizophrenia were overweight and had not used evidence-based weight services. The implementation strategy included data from patient-facing kiosks, continuous data feedback, clinical champions, education, social marketing, and evidence-based quality improvement teams. Mixed methods evaluated the impact of the kiosks on utilization of and retention in weight services. Results Compared with usual care, implementation resulted in individuals being more likely to use weight services, getting services more than 5 weeks sooner, and using 3 times more visits. When compared to the year prior to implementation, patients at implementation sites saw a three-fold increase in treatment visits. Usual care resulted in no change. Conclusions Mental health clinics have been slow to adopt HIT. This study is among the first to implement and evaluate automated collection of data from patients at these clinics. Patient-facing kiosks are feasible in routine care, and provide data that can be used to substantially improve the quality of care.

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“…“Enhancing QUality-of-care In Psychosis” (EQUIP) was a longitudinal VA project that included evaluation of a chronic care model for schizophrenia (see implementation paper for greater details regarding study design 41 ). Data were collected at mental health clinics within the Greater Los Angeles and Long Beach VA Healthcare Systems.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of a Psychosocial Weight Management Program for Individuals with Schizophrenia

Niv

Cohen

Hamilton

et al. 2012

J Behav Health Serv Res

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The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and BMI were assessed at baseline, 1 year later and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed.

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EQUIP: Implementing chronic care principles and applying formative evaluation methods to improve care for schizophrenia: QUERI Series

Cited by 43 publications

References 32 publications

Effectiveness-implementation Hybrid Designs

Effectiveness-implementation Hybrid Designs

Using Patient-facing Kiosks to Support Quality Improvement at Mental Health Clinics

Effectiveness of a Psychosocial Weight Management Program for Individuals with Schizophrenia

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