Economic Production Functions of Schizophrenia Treatment

精神分裂症治疗的经济生产函数

• 批准号: 7816129
• 负责人: DOUGLAS L. LESLIE
• 金额: $ 49.64万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7816129
• 关键词: Affect; Antipsychotic Agents; Behavior Therapy; Behavioral; Caring; Case Management; Clinical; Clinical Data; Clinical effectiveness; Data; Databases; Economics; Effectiveness; Effectiveness of Interventions; Equilibrium; Goals; Guidelines; Health Services; Health Services Accessibility; Health system; Healthcare; Household; Inpatients; Insurance; Insurance Benefits; Intervention; Intervention Trial; Marketing; Measures; Medicaid; Mental Health; Mental Health Services; Mental disorders; Modeling; National Institute of Mental Health; Outcome; Outpatients; Patients; Pattern; Patterns of Care; Pharmacotherapy; Policies; Population; Price; Private Sector; Process; Production; Productivity; Recommendation; Rehabilitation therapy; Relative (related person); Resources; Schizophrenia; Services; Structure; Symptoms; Technology; Time; Uncertainty; United States; Utilization Review; cognitive behavior therapy; cost; insight; programs; routine care; theories

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.

描述（由申请人提供）： 精神分裂症的治疗涉及行为和康复干预以及药物治疗。许多研究已经记录了精神分裂症各种干预和治疗的有效性，但这些研究未能考虑如何将这些治疗纳入整体护理计划。例如，一项发现表明，接受认知行为治疗的患者的精神病症状改善 50% 的可能性是接受常规护理的患者的 8 倍，这表明精神分裂症患者应该获得这些服务，但没有说明认知行为治疗的效果如何行为疗法应与其他治疗相结合，以最少的成本提供最大程度的改善。本研究的目标是开发一种用于治疗精神分裂症的生产函数模型，以便可以在实际实践环境中使用时同时对不同类型的护理对改善患者症状或功能的边际贡献进行建模。随着时间的推移，护理模式的转变（从住院病人到门诊病人，或从行为治疗到药物治疗）将在生产函数框架的背景下进行评估，以确定是否可以改变服务组合以增加患者的利益相同（或更低）的成本。利用 NIMH 临床抗精神病药物干预效果试验 (CATIE)、42 个州的医疗补助计划以及大型私营部门医疗保健索赔数据库的数据，该项目的目标是：1) 估计治疗的生产函数精神分裂症并计算与不同类型服务相关的边际产品； 2) 确定用于治疗精神分裂症的服务的市场价格，并构建这些服务的边际产品与价格的比率； 3) 确定 2003 年至 2007 年精神分裂症护理模式的变化，并确定它们是否与有效提供护理相一致。这项研究的意义是巨大的。有关精神分裂症护理技术和与不同服务相关的边际产品的信息可以帮助为多个层面的政策提供信息，例如制定和完善治疗建议和指南、实施利用审查和病例管理计划、构建保险福利计划以及在公共心理健康系统。许多研究已经记录了精神分裂症各种干预和治疗的有效性，但这些研究未能考虑如何将这些治疗纳入整体护理计划。本研究的目标是利用 NIMH 临床抗精神病药物干预效果试验 (CATIE)、42 个州的医疗补助计划以及大型私营部门医疗保健索赔数据库的数据，开发用于治疗精神分裂症的生产函数模型，以便不同类型的护理对改善患者症状或功能的边际贡献可以在实际实践环境中使用时同时建模。随着时间的推移，护理模式的转变（从住院病人到门诊病人，或从行为治疗到药物治疗）将在生产函数框架的背景下进行评估，以确定是否可以改变服务组合以增加患者的利益相同（或更低）的成本。