DESCRIPTION (Applicant's Abstract): Schizophrenia is a serious, often chronically disabling mental illness that affects about 1% of the general population and exacts high costs. There is substantial evidence that many patients with schizophrenia do not receive treatment that is consistent with existing, empirically proven treatment technologies. This study seeks to advance efforts to enhance the quality of care (QOC) for persons with schizophrenia by implementing newly available QOC assessment methodologies for schizophrenia in a unified service system. These QOC methods include the AHCPR Schizophrenia PORT treatment recommendations, medical record reviews to assess adherence with the PORT recommendations, an innovative approach for summarizing volume of service data, and a brief patient-based outcome measure. The specific aims of the study are: (1) To conduct a field trial of a methodology for assessing QOC provided to patients with schizophrenia in a unified system of care. (2) To test hypotheses linking provider adherence with the PORT treatment recommendations to (a) patterns of service utilization and (b) outcomes, in order to assess the validity of the treatment recommendations as QOC standards. (3) To determine the patient characteristics that correlate with provider adherence with the treatment recommendations. One year retrospective patterns of service utilization and treatment recommendation adherence will be determined on all patients in the service system with an Axis I schizophrenia spectrum disorder (295) diagnosis (N approximately 600) using the system's Volume of Service Information System (VOS) data base and medical record reviews. Prospective (ensuing 6 months) patterns of service utilization, content of care, and outcomes will be assessed for a random sample (N=200) of these patients, who will complete baseline and six month follow-up outcome assessments. The study emphasizes collaboration between the University of Maryland Center for Mental Health Services Research and the University of Maryland Division of Community Psychiatry to implement and assess QOC methods that are applicable to "real world" systems of care.