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.
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