A study of lithium carbonate use in a health maintenance organization.

The Harvard Community Health Plan, a Boston-based health maintenance organization, evaluated the use of lithium carbonate in its mental health department. Criteria were developed for four categories of care: prerequisite workup, initialization of therapy, maintenance of therapy, and management of side effects. Patient records were evaluated for a retrospective control period, an experimental period in which educational interventions (education seminars and reminder notices) were provided to practitioners, and a postexperimental period in which interventions were discontinued. Practitioners' performance improved during the experimental period but declined to control-period levels during the postexperimental period.