Young Alexander S, Cohen Amy N, Hamilton Alison B, Hellemann Gerhard, Reist Christopher, Whelan Fiona
Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.
University of California, Los Angeles, CA, USA.
J Behav Health Serv Res. 2019 Jan;46(1):129-139. doi: 10.1007/s11414-018-9641-8.
"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; χ = 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.
“提高精神病治疗质量”（EQUIP）是一项在八个地点开展的整群对照试验，旨在研究患者报告结局的实施情况及其有效性，以支持循证实践并改善精神分裂症的治疗。实施地点选择改善体重管理。实施措施包括使用信息亭监测患者报告结局、对患者和工作人员进行教育、成立质量改进小组以及进行电话护理管理。通过定性和定量方法对各地点13个月内的实施情况和有效性进行了比较。在随机抽取的801名患者中，80%超重。201名临床医生的能力各不相同。行为体重管理服务的基线使用率较低。在实施地点，与对照地点相比，患者使用体重管理服务的可能性增加了2.3倍（95%置信区间，1.5 - 3.6；χ = 14.4；p < 0.01）。对所开药物导致体重增加的可能性没有影响。在控制基线的情况下，对照地点患者的最终体重比实施地点重5.9±2.7千克（F = 4.8，p = 0.03）。患者报告结局可为循证实践的实施和结局改善提供依据。
