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The reports from the Schizophrenia Patient Outcomes Research Team (PORT) represent an enormous accomplishment. Building on the initial report in 1998 and a first revision in 2003, the team not only evaluated the evidence base that had accumulated over the past 5 years but expanded their focus to incorporate areas beyond mental health, ie, smoking cessation, weight loss, and substance abuse.
As important as this work is in providing guidance on evidence-based clinical practice, these reports by themselves do not ensure an impact on policy and practice. The Institute of Medicine (IOM) Quality Chasm1 report documented the enormous gaps between the health care that Americans should be receiving and the care they actually receive. The subsequent IOM report on Improving the Quality of Healthcare for Mental and Substance Use Conditions2 documented these same gaps in behavioral health and provided a set of aims, principles, and strategies for fundamentally altering the mental health care system to improve the quality of care (which, as indicated by the PORT, is particularly problematic for individuals with schizophrenia). An overall framework for applying these elements is depicted in figure 1 and suggests a series of additional steps:
The Schizophrenia PORT is to be congratulated for taking a major step toward improving the quality of care for individuals with schizophrenia. Multiple other groups (both public and private) must now move much more forcefully through these additional steps to assure that better outcomes of care are realized: National Institute of Mental Health, Substance Abuse and Mental Health Services Administration, Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services, NQF, the Joint Commission, American Psychiatric Association, National Committee for Quality Assurance, Department of Defense, Department of Veterans' Affairs, as well as the PORT, all have a role. The blueprint has been well specified in the IOM reports, but it has largely not been implemented in mental health. Perhaps the opportunity presented by health care reform will be a stimulus to action. As noted by the quotation from Goethe on the title page of each Institute of Medicine Quality Chasm reports “To know is not enough; we must apply. Willing is not enough; we must do.”
Irving Institute for Clinical and Translational Research at Columbia University (UL1 RR024156) and University of Pittsburgh's Clinical and Translational Science Institute (UL1 RR024153), both from the National Center for Research Resources, a component of the National Institutes of Health; Mental Heath Therapeutics CERT at Rutgers; State University of New Jersey, subcontract to Columbia University; Agency for Health care Research and Quality (5 U18 HS016097).