DESCRIPTION (provided by applicant): Treatment for schizophrenia involves both behavioral and rehabilitation interventions and pharmacotherapy. A number of studies have documented the effectiveness of various interventions and treatments for schizophrenia, but these studies fail to consider how these treatments should be incorporated into an overall program of care. For example, a finding that patients who receive cognitive behavioral therapy are 8 times more likely to have a 50% improvement in psychotic symptoms than patients who receive routine care suggests that patients with schizophrenia should have access to these services, but does not say how cognitive behavioral therapy should be combined with other treatments to provide the maximum level of improvement for the least cost. The goal of this study is to develop a production function model for the treatment of schizophrenia, so that the marginal contributions of different types of care to improvements in patient symptoms or functioning can be modeled simultaneously as they are used in actual practice settings. Shifts in patterns of care over time (from the inpatient to outpatient setting, or from behavioral therapy to pharmacotherapy) will be evaluated in the context of the production function framework to determine whether the mix of services can be altered to increase the benefit to patients for the same (or lower) cost. Using data from the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), the Medicaid programs of 42 states, and a large private-sector health care claims database, the aims of the project are: 1) to estimate a production function for the treatment of schizophrenia and calculate marginal products associated with different types of services; 2) to determine market prices for services used to treat schizophrenia and construct ratios of marginal product to price for these services; and 3) to identify changes in patterns of care for schizophrenia from 2003 to 2007 and determine whether they are consistent with the efficient provision of care. The implications of the study are considerable. Information about the technology of care for schizophrenia and marginal products associated with different services can help inform policies on many levels, such as developing and refining treatment recommendations and guidelines, implementing utilization review and case management programs, structuring insurance benefit plans, and allocating resources in public mental health systems. A number of studies have documented the effectiveness of various interventions and treatments for schizophrenia, but these studies fail to consider how these treatments should be incorporated into an overall program of care. Using data from the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), the Medicaid programs of 42 states, and a large private-sector health care claims database, the goal of this study is to develop a production function model for the treatment of schizophrenia, so that the marginal contributions of different types of care to improvements in patient symptoms or functioning can be modeled simultaneously as they are used in actual practice settings. Shifts in patterns of care over time (from the inpatient to outpatient setting, or from behavioral therapy to pharmacotherapy) will be evaluated in the context of the production function framework to determine whether the mix of services can be altered to increase the benefit to patients for the same (or lower) cost.

Project narrative A number of studies have documented the effectiveness of various interventions and treatments for schizophrenia, but these studies fail to consider how these treatments should be incorporated into an overall program of care. Using data from the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), the Medicaid programs of 42 states, and a large private-sector health care claims database, the goal of this study is to develop a production function model for the treatment of schizophrenia, so that the marginal contributions of different types of care to improvements in patient symptoms or functioning can be modeled simultaneously as they are used in actual practice settings. Shifts in patterns of care over time (from the inpatient to outpatient setting, or from behavioral therapy to pharmacotherapy) will be evaluated in the context of the production function framework to determine whether the mix of services can be altered to increase the benefit to patients for the same (or lower) cost.