Improving Care and Reducing Cost Study

The goal of the Improving Care and Reducing Cost (ICRC) Program, is to improve disease
management and the overall process of care in treating the chronic illness schizophrenia in
order to reduce ER visits and hospital days while providing better care, better health and
increased patient satisfaction. This will be done by fostering innovation in the use of
technology and by training and deploying a new cadre of personnel in the behavioral health
field: Mental Health/Health Technology (MH/HT) Case Managers. The specific treatments we
propose to use are evidence based, but their dissemination has been limited because of lack
of trained personnel and cost. The model we propose, the Health Technology Program (HTP),
will address these problems through use of the web and mobile phone based training and
interventions.

The components of the HTP program that are being tested in the pilot program include: 1)
evidence-based pharmacological treatment facilitated by a web-based prescriber decision
support system-Prescriber Decision Assistant (PDA) 2) brief, in-person, relapse prevention
counseling with supplemental web-based learning modules, 3) a daily support website that
offers web- and phone-based resources to support persons with schizophrenia and their family
members or others. The resources include a patient and family Psycho-Education Treatment
program, which includes electronic peer groups facilitated by mental health professionals,
providing medication reminders via web and phone, and conducting monitoring of early warning
signs of relapse via web and phone 4) an interactive smart phone text-messaging application
to support medication adherence, facilitate coping with symptoms and improve daily
functioning in individuals with schizophrenia 5) a web-based, self-administered
cognitive-behavioral therapy (CBT) program for the management of hallucinations. All
patients will be provided with pharmacological treatment (PDA), brief in-person relapse
prevention counseling, and an Android mobile phone. The other program components will be
provided to patients using a shared decision-making approach to assess need and preference.

Inclusion Criteria:

- • Age 18 to 60, (patients age 51-60 require review from the coordinating site)

- Clinical diagnosis of:

- schizophrenia

- schizoaffective disorder

- psychosis NOS

- Has had two or more inpatient hospitalizations for treatment of a psychotic
disorder

- Currently in the hospital or up to 30 days of inpatient hospitalization for a
psychotic disorder

o If patients are sent to a partial, or day hospital following an inpatient
hospitalization, the 30 day window begins at the time of discharge from the day
or partial hospital

- Any ethnicity

- Ability to participate in research assessments in English

- Ability to provide fully informed consent

Exclusion Criteria:

- • Individuals who cannot understand what research participation entails, or correctly
answer the questions about research participation that are part of the Study
Information Review and provide fully informed consent will be excluded

- More than 30 days since discharge from a psychiatric hospitalization

- Any other serious medical condition that in the opinion of the investigator
would seriously impair functioning making the patient unsuitable for the trial

- Patients who would likely find it burdensome and/or have difficulty sustaining
the use of a laptop computer and /or smart phone due to issues of security,
consistent connectivity or other factors.