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Speech by John Eisenberg, MD, Administrator,
Given March 24, 1998, at the National Press Club, Washington, DC
Good morning. On March 13, President Clinton accepted the report of the National Advisory
Commission on Consumer Protection and Quality in the Health Care Industry. In his
remarks, he noted that for all of the strengths of the American health care system, many gaps still
exist. He challenged all of us to "seize this moment of opportunity to improve the quality of
health care for all our people."
The landmark study on schizophrenia that we are releasing today is a move toward meeting the
President's challenge (select for press release). The findings of
this research provide critical
information needed to improve the quality of care—and the quality of life—for people
schizophrenia. This study (1, 2) gives clinicians, patients, and their families the basic,
evidence-based information they need to formulate a comprehensive treatment plan for their
This study represents a collaboration between two Government agencies and, ultimately, the
private sector. I am proud that AHCPR was able to fund this project jointly with the National
Institute of Mental Health, and that the National Alliance
for the Mentally Ill has built on the
findings to work directly with patients and their families.
The study is one of AHCPR's Patient Outcomes Research Teams, or PORTs, which examine the
effectiveness and cost-effectiveness of available treatments for common clinical conditions.
AHCPR's 25 PORTs focus on procedures and treatments whose use in the "real world" setting of
medical practice has not been rigorously examined.
The schizophrenia PORT identified room for improvement in the care of people with this
devastating disease. Dr. Lehman and his team found that less than 50 percent of patients are
receiving appropriate doses of antipsychotic medications. They also found gaps in the use and
availability of psychosocial and vocational therapies and family interventions.
In the year since I joined AHCPR, I have often been asked what health services research is and
how it can change the every day practice of medicine. This study provides a very good answer.
Dr. Lehman's team have done what good health services researchers should do: They identified
the evidence for treating an important health problem and evaluated the quality of the evidence.
They knew that the evidence for quality of care depends on the quality of the evidence. Then they
assessed existing patterns of care for people with schizophrenia. Where there are gaps between
what we do and what we should do for our patients, then health care research provides clear
opportunities for improvement.
These are two essential pieces of the puzzle of improving the quality of health
scientific foundation to identify best practice, in this case for schizophrenia, and comparing it with
current practice. These are necessary steps before taking the third step in improving the quality of
care for people with schizophrenia.
The third step is the adoption and implementation of this evidence into all aspects of care for
people with schizophrenia. This includes community-based care, family education and support,
and proper medication. Dr. Lehman and his team emphasize the importance of therapies and
interventions other than medication. However, they note that behavioral interventions have not
been studied as extensively and rigorously as pharmacological treatments. Dr. Lehman will
describe the findings of the study in a few moments.
We are pleased that the National Alliance for the Mentally Ill has embraced the findings of this
study, and plans to promote the findings of this research throughout its network of patients,
families and affiliated organizations. That kind of collaboration with private sector leaders makes
me convinced that we have served the public well by investing our research funds in this area. I
expect clinicians and other providers to use this evidence to provide the best possible care for
people with schizophrenia.
I would like to commend Dr. Lehman and his team for an excellent study. My goal for AHCPR is
to continue to fund work like Dr. Lehman's—innovative, evidence-based research from the
and brightest in health services research.
1. Lehman AF, Steinwachs DM, and Co-Investigators of the PORT Project. Translating research into practice: The schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. Schizophrenia Bulletin 24(1): 1-10, 1998.
2. Lehman AF, Steinwachs DM, and Survey Co-Investigators of the PORT Project. Patterns of usual care for schizophrenia: Initial results from the schizophrenia Patient Outcomes Research Team (PORT) Client Survey. Schizophrenia Bulletin 24(1): 11-20, 1998
Current as of March 1998