Abstract

We propose a systematic investigation of the structure, processes and outcomes of treatment provided in managed care plans for adults who have schizophrenia and compare their care and outcomes with that provided similar subjects whose treatment is not managed. This is a prospective longitudinal observational study, designed to enroll and follow 700 adults with schizophrenia who have been evaluated for hospital admission by Emergency Services Team (ESTs) in Massachusetts. The theoretical framework for the study comes from Avedis Donabedian, MD, a leading scholar in the field of quality assessment. Our study has the following specific aims:
Aim 1 : To describe the structure of care: how emergency services operate, the characteristics of the providers to who clients are referred after evaluation, and the characteristics of the clients themselves.
Aim 2 : To assess the appropriateness of the process of care for adults with schizophrenia and compare managed treatment on the level of appropriateness.
Aim 3 : To compare clinical and functional outcomes for managed and not-managed clients, adjusted for the appropriateness of their treatment.
Aim 4 : To compare per person managed and unmanaged care expenditures. Medicaid managed care clients will be compared to Medicare/Medicaid clients (whose care is not managed) post-crisis. Data will be collected through anthropological observations, interviews with clients, clinical assessments, medical records, and complete service use records compiled from DMH files, paid claims from Medicare and Medicaid. The study will be carried out in three regions, Boston, Central and Western Massachusetts.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH054076-04
Application #
6165162
Study Section
Special Emphasis Panel (ZMH1-CRB-B (O4))
Program Officer
Rupp, Agnes
Project Start
1997-03-01
Project End
2002-07-31
Budget Start
2000-05-01
Budget End
2002-07-31
Support Year
4
Fiscal Year
2000
Total Cost
$455,825
Indirect Cost

  Institution

Name
Harvard University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
082359691
City
Boston
State
MA
Country
United States
Zip Code
02115

  Publications

Dickey, Barbara; Normand, Sharon-Lise T; Eisen, Sue et al. (2006) Associations between adherence to guidelines for antipsychotic dose and health status, side effects, and patient care experiences. Med Care 44:827-34
Ware, Norma C; Tugenberg, Toni; Dickey, Barbara (2004) Practitioner relationships and quality of care for low-income persons with serious mental illness. Psychiatr Serv 55:555-9
Dickey, Barbara; Normand, Sharon-Lise T (2004) Toward a model for testing the relationship between quality of care and costs. J Ment Health Policy Econ 7:15-21
Dickey, Barbara (2004) Best practices: are financial incentives and best practices compatible? Psychiatr Serv 55:130-1
Dickey, Barbara; Normand, Sharon-Lise T; Hermann, Richard C et al. (2003) Guideline recommendations for treatment of schizophrenia: the impact of managed care. Arch Gen Psychiatry 60:340-8
Norton, Edward C; Van Houtven, Courtney Harold; Lindrooth, Richard C et al. (2002) Does prospective payment reduce inpatient length of stay? Health Econ 11:377-87
Norton, E C; Lindrooth, R C; Dickey, B (1999) Cost-shifting in manged care. Ment Health Serv Res 1:185-96
Dickey, B; Hermann, R C; Eisen, S V (1998) Assessing the quality of psychiatric care: research methods and application in clinical practice. Harv Rev Psychiatry 6:88-96
Dickey, B; Norton, E C; Normand, S L et al. (1998) Managed mental health experience in Massachusetts. New Dir Ment Health Serv :115-22
Fisher, W H; Lindrooth, R C; Norton, E C et al. (1998) How managed care organizations develop selective contracting networks for psychiatric inpatient care: a Massachusetts case study. Inquiry 35:417-31

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