Skip to main content

Advertisement

SpringerLink
Log in

Implementing Patient-Reported Outcomes to Improve the Quality of Care for Weight of Patients with Schizophrenia

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

“Enhancing QUality of Care In Psychosis” (EQUIP) was an eight-site clustered controlled trial of the implementation and effectiveness of patient-reported outcomes to support evidence-based practice and improve care for schizophrenia. Implementation sites chose to improve care for weight. Implementation included monitoring patient-reported outcomes using kiosks, patient and staff education, quality improvement teams, and phone care management. Qualitative and quantitative methods compared implementation and effectiveness between sites for 13 months. Eighty percent of 801 randomly selected patients were overweight. Two hundred one clinicians varied in competency. Baseline use of behavioral weight services was low. At implementation sites, patients became 2.3 times more likely to use weight services compared with control sites (95% CI, 1.5–3.6; χ2 = 14.4; p < 0.01). There was no effect on the weight gain liability of medications prescribed. Controlling for baseline, patients’ final weight at control sites was 5.9 ± 2.7 kg heavier than at implementation sites (F = 4.8, p = 0.03). Patient-reported outcomes can inform implementation of evidence-based practice and improvement in outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

REFERENCES

  1. Kreyenbuhl J, Buchanan RW, Dickerson FB, et al. The Schizophrenia Patient Outcomes Research Team (PORT): Updated Treatment Recommendations 2009. Schizophrenia Bulletin. 2010;36(1):94–103.

    Article  Google Scholar 

  2. Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders. Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, DC: National Academies Press; 2006.

    Google Scholar 

  3. Young AS, Niv N, Cohen AN, et al. The Appropriateness of Routine Medication Treatment for Schizophrenia. Schizophrenia Bulletin. 2010;36(4):732–739.

    Article  Google Scholar 

  4. Greenhalgh J, Dalkin S, Gooding K, et al. Functionality and feedback: A realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care. Health Services and Delivery Research. 2017;5(2). https://doi.org/10.3310/hsdr05020.

  5. Rush AJ. Isn't it About Time to Employ Measurement-based Care in Practice? American Journal of Psychiatry. 2015;172(10):934–936.

    Article  Google Scholar 

  6. Gleacher AA, Olin SS, Nadeem E, et al. Implementing a Measurement Feedback System in Community Mental Health Clinics: A Case Study of Multilevel Barriers and Facilitators. Administration and Policy in Mental Health Services Research. 2016;43(3):426–440.

    Article  Google Scholar 

  7. Marder SR, Essock SM, Miller AL, et al. Physical Health Monitoring of Patients with Schizophrenia. American Journal of Psychiatry. 2004;161(8):1334–1349.

    Article  Google Scholar 

  8. Saha S, Chant D, McGrath J. A Systematic Review of Mortality in Schizophrenia: Is the Differential Mortality Gap Worsening Over Time? Archives General Psychiatry. 2007;64(10):1123–1131.

    Article  Google Scholar 

  9. Holt RI, Pendlebury J, Wildgust HJ, et al. Intentional Weight Loss in Overweight and Obese Patients with Severe Mental Illness: 8-Year Experience of a Behavioral Treatment Program. Journal of Clinical Psychiatry. 2010;71(6):800–805.

    Article  Google Scholar 

  10. Daumit GL, Dickerson FB, Wang NY, et al. A Behavioral Weight-loss Intervention in Persons with Serious Mental Illness. New England Journal of Medicine. 2013;368(17):1594–1602.

    Article  CAS  Google Scholar 

  11. Dixon LB, Dickerson F, Bellack AS, et al. The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements. Schizophrenia Bulletin. 2010;36(1):48–70.

    Article  Google Scholar 

  12. Weeks WB, Bott DM, Lamkin RP, et al. Veterans Health Administration and Medicare Outpatient Healthcare Utilization by Older Rural and Urban New England Veterans. Journal of Rural Health 2005;21(2):167–171.

    Article  Google Scholar 

  13. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. New England Journal of Medicine. 2002;346(6):393–403.

    Article  CAS  Google Scholar 

  14. National Institutes of Health. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. Bethesda, MD: National Institutes of Health; 1998. https://www.ncbi.nlm.nih.gov/books/NBK2003/. Accessed October 14, 2018

  15. Steinwachs DM. Transforming Public Health Systems: Using Data to Drive Organizational Capacity for Quality Improvement and Efficiency. Generating Evidence & Methods to Improve Patient Outcomes. 2014;2(4):1175.

    Google Scholar 

  16. Young AS, Niv N, Chinman M, et al. Routine Outcomes Monitoring to Support Improving Care for Schizophrenia: Report from the VA Mental Health QUERI. Community Mental Health Journal. 2011;47(2):123–135.

    Article  Google Scholar 

  17. Gilbody SM, House AO, Sheldon TA. Psychiatrists in the UK Do Not Use Outcome Measures. National Survey. British Journal of Psychiatry. 2002;180(2):101–103.

    Article  Google Scholar 

  18. Young AS. Routinely Measuring Schizophrenia Treatment Quality--Shortcomings with Medical Records. Medical Care. 2007;45(1):104.

    Article  Google Scholar 

  19. Druss B, Rosenheck R. Evaluation of the HEDIS Measure of Behavioral Health Care Quality. Health Plan Employer Data and Information Set. Psychiatric Services. 1997;48(1):71–75.

    Article  CAS  Google Scholar 

  20. Cohen AN, Chinman MJ, Hamilton AB, et al. Using Patient-facing Kiosks to Support Quality Improvement at Mental Health Clinics. Medical Care. 2013;51(3 Suppl 1):S13-S20.

    Article  Google Scholar 

  21. Gilbody SM, House AO, Sheldon TA. Outcome Measures and Needs Assessment Tools for Schizophrenia and Related Disorders. Cochrane Database of Systematic Reviews. 2003;1:CD003081.

    Google Scholar 

  22. Shimokawa K, Lambert MJ, Smart DW. Enhancing Treatment Outcome of Patients at Risk of Treatment Failure: Meta-analytic and Mega-analytic Review of a Psychotherapy Quality Assurance System. Journal of Consulting and Clinical Psychology. 2010;78(3):298–311.

    Article  Google Scholar 

  23. de Jong K, van Sluis P, Nugter MA, et al. Understanding the Differential Impact of Outcome Monitoring: Therapist Variables that Moderate Feedback Effects in a Randomized Clinical Trial. Psychotherapy Research. 2012;22(4):464–474.

    Article  Google Scholar 

  24. Merrill RM, Aldana SG, Bowden DE. Employee Weight Management Through Health Coaching. Eating and Weight Disorders. 2010;15(1–2):e52-e59.

    Article  CAS  Google Scholar 

  25. Puschner B, Schofer D, Knaup C, et al. Outcome Management in Inpatient Psychiatric Care. Acta Psychiatrica Scandinavica. 2009;120(4):308–319.

    Article  CAS  Google Scholar 

  26. Miller AL, Crismon ML, Rush AJ, et al. The Texas Medication Algorithm Project: Clinical Results for Schizophrenia. Schizophrenia Bulletin. 2004;30(3):627–647.

    Article  Google Scholar 

  27. Hamilton AB, Cohen AN, Glover DL, et al. Implementation of Evidence-Based Employment Services in Specialty Mental Health. Health Services Research. 2013;48(6 Pt 2):2224–2244.

    Article  Google Scholar 

  28. Brown AH, Cohen AN, Chinman M, et al. EQUIP: Implementing Chronic Care Principles and Applying Formative Evaluation Methods to Improve Care for Schizophrenia. Implementation Science. 2008;3(1):9.

    Article  Google Scholar 

  29. Chinman M, Young AS, Schell T, et al. Computer-Assisted Self-Assessment in Persons with Severe Mental Illness. Journal of Clinical Psychiatry. 2004;65(10):1343–1351.

    Article  Google Scholar 

  30. Littrell KH, Hilligoss NM, Kirshner CD, et al. The Effects of an Educational Intervention on Antipsychotic-induced Weight Gain. Journal of Nursing Scholarship. 2003;35(3):237–241.

    Article  Google Scholar 

  31. Rubenstein LV, Parker LE, Meredith LS, et al. Understanding Team-based Quality Improvement for Depression in Primary Care. Health Services Research. 2002;37(4):1009–1029.

    Article  Google Scholar 

  32. First MB, Spitzer RL, Gibbon M, et al. Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Patient Edition, Version 2.0. New York: New York State Psychiatric Institute; 1995.

    Google Scholar 

  33. Ventura J, Lukoff D, Nuechterlein KH, et al. Brief Psychiatric Rating Scale (BPRS) Expanded Version (4.0): Scales, Anchor Points and Administration Manual. International Journal of Methods in Psychiatric Research. 1993;3:227–243.

    Google Scholar 

  34. Niv N, Cohen AN, Sullivan G, et al. The MIRECC Version of the Global Assessment of Functioning Scale: Reliability and Validity. Psychiatric Services. 2007;58(4):529–535.

    Article  Google Scholar 

  35. Newcomer JW. Metabolic Considerations in the Use of Antipsychotic Medications: a Review of Recent Evidence. Journal of Clinical Psychiatry. 2007;68(suppl 1):20–27.

    CAS  PubMed  Google Scholar 

  36. Simpson DD. A Conceptual Framework for Transferring Research to Practice. Journal of Substance Abuse Treatment. 2002;22(4):171–182.

    Article  Google Scholar 

  37. Glaser BG, Strauss AL. Discovery of Substantive Theory: A Basic Strategy Underlying Qualitative Research. American Behavioral Scientist. 1965;8(6):5–12.

    Article  Google Scholar 

  38. Boeije H. A Purposeful Approach to the Constant Comparative Method in the Analysis of Qualitative Interviews. Qualitative and Quantitative Sociology. 2002;36(4):391–409.

    Article  Google Scholar 

  39. Hamilton A, Cohen A, Young A. Organizational Readiness in Specialty Mental Health Care. Journal of Internal Medicine. 2010;25(1):27–31.

    Google Scholar 

  40. Concato J, Shah N, Horwitz RI. Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs. New England Journal of Medicine. 2000;342(25):1887–1892.

    Article  CAS  Google Scholar 

  41. Owen RR, Hudson T, Thrush C, et al. The Effectiveness of Guideline Implementation Strategies on Improving Antipsychotic Medication Management for Schizophrenia. Medical Care. 2008;46(7):686–691.

    Article  Google Scholar 

  42. Young A, Cohen A, Miotto K. Improving the Quality of Care for Serious Mental Illness. In: O’Donohue W, Maragakis A, eds. Quality Improvement in Behavioral Health. Swizerland: Springer International; 2016:275–288.

    Google Scholar 

Download references

Acknowledgements

This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service Quality Enhancement Research Initiative (MNT 03-213), and VISN 22 Mental Illness Research, Education, and Clinical Center (MIRECC). Views expressed in this article are those of the authors and do not necessarily represent the views of any affiliated institutions. The authors would like to thank the investigators, staff, and clinicians of the EQUIP project at the Department of Veterans Affairs Healthcare Centers at Bronx, NY; Houston, TX; Long Beach, CA; Los Angeles, CA; Northport, NY; Shreveport, LA; Temple, TX; and Waco, TX.

Author information

Authors and Affiliations

  1. Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA

    Alexander S. Young MD, MSHS, Amy N. Cohen PhD & Alison B. Hamilton PhD, MPH

  2. University of California, Los Angeles, CA, USA

    Alexander S. Young MD, MSHS, Amy N. Cohen PhD, Alison B. Hamilton PhD, MPH, Gerhard Hellemann PhD & Fiona Whelan MS

  3. UCLA Center for Health Services, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, 90024, USA

    Alexander S. Young MD, MSHS

  4. Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA

    Alexander S. Young MD, MSHS, Amy N. Cohen PhD, Alison B. Hamilton PhD, MPH, Gerhard Hellemann PhD & Christopher Reist MD

  5. Long Beach Veterans Healthcare System, Long Beach, CA, USA

    Christopher Reist MD

  6. University of California, Irvine, CA, USA

    Christopher Reist MD

Authors
  1. Alexander S. Young MD, MSHS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amy N. Cohen PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alison B. Hamilton PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerhard Hellemann PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher Reist MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fiona Whelan MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander S. Young MD, MSHS.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Young, A.S., Cohen, A.N., Hamilton, A.B. et al. Implementing Patient-Reported Outcomes to Improve the Quality of Care for Weight of Patients with Schizophrenia. J Behav Health Serv Res 46, 129–139 (2019). https://doi.org/10.1007/s11414-018-9641-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-018-9641-8

Search

Navigation