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Cited by 53Health Policy Implementation ScienceSchizophrenia research and treatmentPsychiatric care and mental health services

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

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Brown, Alison H, Cohen, Amy N, Chinman, Matthew J, Kessler, Christopher, Young, Alexander S·2008·Implementation Science
DOI 10.1186/1748-5908-3-9PMC PMC2278162
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Abstract

BACKGROUND: This paper presents a case study that demonstrates the evolution of a project entitled "Enhancing QUality-of-care In Psychosis" (EQUIP) that began approximately when the U.S. Department of Veterans Affairs' Quality Enhancement Research Initiative (QUERI), and implementation science were emerging. EQUIP developed methods and tools to implement chronic illness care principles in the treatment of schizophrenia, and evaluated this implementation using a small-scale controlled trial. The next iteration of the project, EQUIP-2, was further informed by implementation science and the use of QUERI tools. METHODS: This paper reports the background, development, results and implications of EQUIP, and also describes ongoing work in the second phase of the project (EQUIP-2). The EQUIP intervention uses implementation strategies and tools to increase the adoption and implementation of chronic illness care principles. In EQUIP-2, these strategies and tools are conceptually grounded in a stages-of-change model, and include clinical and delivery system interventions and adoption/implementation tools. Formative evaluation occurs in conjunction with the intervention, and includes developmental, progress-focused, implementation-focused, and interpretive evaluation. RESULTS: Evaluation of EQUIP provided an understanding of quality gaps and how to address related problems in schizophrenia. EQUIP showed that solutions to quality problems in schizophrenia differ by treatment domain and are exacerbated by a lack of awareness of evidence-based practices. EQUIP also showed that improving care requires creating resources for physicians to help them easily implement practice changes, plus intensive education as well as product champions who help physicians use these resources. Organizational changes, such as the addition of care managers and informatics systems, were shown to help physicians with identifying problems, making referrals, and monitoring follow-up. In EQUIP-2, which is currently in progress, these initial findings were used to develop a more comprehensive approach to implementing and evaluating the chronic illness care model. DISCUSSION: In QUERI, small-scale projects contribute to the development and enhancement of hands-on, action-oriented service-directed projects that are grounded in current implementation science. This project supports the concept that QUERI tools can be useful in implementing complex care models oriented toward evidence-based improvement of clinical care.

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  • The Hybrid Type 2 EQUIP study was an 8-site VA study where 4 sites were randomized to a chronic illness care model for schizophrenia supported by an implementation strategy (facilitation, quality improvement teams, quality reports, etc.).

    “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.).”

    From Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact (2012) · cites this paper as [31]

    The EQUIP-2 overview describes an eight-site VA evaluation, and the Adoption/implementation tools and Delivery system interventions sections describe implementation teams and Quality Reports. But EQUIP research design and methods says psychiatrists—not four sites—were randomized at two clinics, with a third clinic assigned to control. The cited paper does not support the claim that four of the eight sites were randomized. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • The EQUIP study gathered clinical and implementation outcome data at all sites.

    “The study gathered clinical and implementation outcome data at all sites.”

    From Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact (2012) · cites this paper as [31]

    The EQUIP Methods section describes clinical outcomes data collected through MINT and interviews and surveys assessing implementation. It does not establish that both types of outcome data were gathered at every site; the described clinical assessments were for intervention patients, and implementation interviews were attempted with clinicians in both study arms. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The investigators of the EQUIP study recognized a need to test implementation strategies to support recovery-oriented interventions for persons with schizophrenia, as many guidelines and VA directives were encouraging the use of recovery-oriented programs even with less than ideal effectiveness research support.

    “The investigators recognized a need to test implementation strategies to support recovery-oriented interventions for persons with schizophrenia, as many guidelines and VA directives were encouraging the use of recovery-oriented programs even in the case of less than ideal effectiveness research support.”

    From Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact (2012) · cites this paper as [31]

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References 45 · Cited by 53

Research works printed but not linked: 30

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Authors
Brown, A. H., Cohen, A. N., Chinman, M. J., Kessler, C., & Young, A. S.
Affiliations
  • University of California, Los Angeles (US)
  • RAND Corporation (US)
  • VA Greater Los Angeles Healthcare System (US)
Corresponding author
Brown, Alison H
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2008-02-15
Volume
3
Issue
1
Pages
9-9
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/1748-5908-3-9
PMC
PMC2278162
OpenAlex
W1971269564
Cited by
53
References
45
Citations by year
2025: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 4 · 2016: 1 · 2015: 5 · 2014: 5 · 2013: 9 · 2012: 4
FWCI
8.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • National Institutes of Health (5p30mh068639-05)
  • National Institute of Mental Health (P30-MH068639)
  • NIH Clinical Center
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
schizophrenia, EQUIP, formative assessment, stages of change, evidence-based practice adoption, care managers, physician training, veterans' mental health services

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