While much has been learned in recent years about the efficacy of specific pharmacological, psychotherapeutic, rehabilitative, and other therapies for persons with severe mental illness, understandings of the effects of different organizational forms within which such interventions are delivered have remained limited. This proposed study explores how various patient outcomes in this population are related to different characteristics of mental health systems in which services are delivered, and various factors associated with the provider organizations which take primary responsibility for patients' care. Patient outcomes will include aspects of symptoms, activities of daily living, social activities, employment, and housing. The association of patient outcomes with specific variables and constellations of variables in the key conceptual categories of resources, technology, structure, culture, and management will be examined, comparing and contrasting variables representing these concepts across system and provider organizations. Hierarchical modeling techniques will be employed to examine these relationships. Statistical controls for system characteristics variables, such as rurality and population size, and for patient severity variables, such as prior hospitalizations, will be introduced to control for differences in community context and patient mix. Currently existing data from a unique cross-sectional study of 10 separate systems, including 42 primary provider organizations and 353 staff of these organizations will be used to examine the outcomes in a population of about 1500 patients with severe mental illness living in rural and small cities in Wisconsin.
