Effectiveness research evaluates the outcomes of care provided under ordinary circumstances to the usual mix of clients seen in an average service setting. To advance effectiveness research in mental health, the field needs a common core of comprehensive, standardized, validated instruments that can be used across sites, settings, interventions, and populations. These instruments must also be brief, easily administered, and inexpensive. No such instrument is available to measure outcomes in schizophrenia.

Our long-term objective is to develop a core outcomes assessment instrument for schizophrenia that will work across settings and subpopulations to permit meaningful comparisons among groups.

This proposal describes a project to develop such an instrument by building on previous work to construct and field test a prototype schizophrenia outcomes module (SCHIZOM), a comparatively brief, yet comprehensive set of questionnaires to assess outcomes of care for schizophrenia. The proposed project will remedy weaknesses observed in the prototype and assess the psychometric properties of the revised module in important subpopulations.

SPECIFIC OBJECTIVES ARE: (1) to revise and strengthen the current prototype by (a) broadening the module's psychiatric status measure, (b) improving the reliability and validity of functioning measures showing poor respondent concordance, and (c) increasing module efficiency, and (2) to evaluate the performance of the revised module in four important subgroups of individuals with schizophrenia (a) those with a comorbid substance use disorder, (b) women, (c) African Americans, and (d) rural residents.

Modification of the module (Objective 1) will be informed by psychometric analysis of data from the initial field test for the prototype SCHIZOM, from a complementary RAND dataset, and from interviews with 25 "triplets" consisting of an individual with schizophrenia, a family member/friend, and a mental health care provider. The revised module will be field tested (Objective 2) through a longitudinal study (baseline and 6-month follow-up) of 190 individuals, aged 18-65, with a SCID-confirmed diagnosis of schizophrenia. Standard psychometric techniques will be used to assess the reliability (internal consistency and test-retest) and validity (face, concurrent, and sensitivity to change) of the modified module, overall and in each of the major subgroups.

The proposed activities are essential to making the Schizophrenia Outcomes Module a state-of-the-art tool for effectiveness research in schizophrenia. A standardized instrument with well established psychometric characteristics in major clinical, cultural, and demographic subpopulations will not only (1) advance the research field by insuring the availability of a common core dataset for comparison of outcomes across studies, but will also (2) facilitate routine outcomes monitoring by CMHCs and other providers allowing them to identify and address problems in quality of care, and (3) provide a tool that state mental health systems can use to hold managed care companies, CMHCs, and other providers accountable for the care provided to people with schizophrenia.

R01MH055170

1996-05-01

2001-04-30