Economic Production Functions of Schizophrenia Treatment

精神分裂症治疗的经济生产函数

• 批准号: 7940971
• 负责人: DOUGLAS L. LESLIE
• 金额: $ 41.79万
• 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 2011-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7940971
• 关键词: Affect; Antipsychotic Agents; Behavior Therapy; Behavioral; Caring; Case Management; Clinical; Clinical Data; Clinical effectiveness; Cognitive Therapy; 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; 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措施和药物治疗。许多研究证明了各种干预措施和精神分裂症的有效性，但是这些研究未能考虑应如何将这些治疗方法纳入整体护理计划。例如，这一发现是，接受认知行为疗法的患者比接受常规护理的患者的精神病症状提高50％的可能性高出8倍，这表明精神分裂症患者应该可以使用这些服务，但不应表明应与其他治疗相结合以最大程度地提高成本。这项研究的目的是开发一种用于治疗精神分裂症的生产功能模型，以便可以同时建模不同类型的护理对改善患者症状或功能的边际贡献，因为它们在实际练习环境中使用。随着时间的流逝，护理模式（从住院到门诊环境或从行为疗法到药物治疗）的转变将在生产功能框架的背景下进行评估，以确定是否可以改变服务的组合以增加相同（或较低）成本的患者的好处。使用NIMH临床抗精神病药试验（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，该项目的目的是：1）估算治疗精神分裂症的生产功能并计算与不同类型的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和边际产品与这些服务的价格的构建比； 3）从2003年到2007年确定精神分裂症的护理模式的变化，并确定它们是否与有效的护理提供一致。该研究的含义很大。有关与不同服务相关的精神分裂症和边际产品护理技术的信息，可以帮助许多层面的政策，例如制定和完善治疗建议和准则，实施利用率审查和案例管理计划，构建保险福利计划以及在公共心理健康系统中分配资源。许多研究证明了各种干预措施和精神分裂症的有效性，但是这些研究未能考虑应如何将这些治疗方法纳入整体护理计划。使用NIMH临床抗精神病药试验（CATIE），42个州的医疗补助计划以及大量私营部门医疗保健索赔的数据，这项研究的目的是为治疗精神分裂症的治疗建立生产功能模型，以便将不同类型的护理对患者症状进行改善的效果可以进行自动效果，从而进行了模型。随着时间的流逝，护理模式（从住院到门诊环境或从行为疗法到药物治疗）的转变将在生产功能框架的背景下进行评估，以确定是否可以改变服务的组合以增加相同（或较低）成本的患者的好处。