title: No Magic Bullet: A Theory-Based Meta-Analysis of Markov Transition Probabilities in Studies of Service Systems for Persons With Mental Disabilities.
abstract: A random-effects meta-analysis of studies that used Markov transition probabilities (TPs) to describe outcomes for mental health service systems of differing quality for persons with serious mental illness was implemented to improve the scientific understanding of systems performance, to use in planning simulations to project service system costs and outcomes over time, and to test a theory of how outcomes for systems varying in quality differ.
  
  
  
  Nineteen systems described in 12 studies were coded as basic (B), maintenance (M), and recovery oriented (R) on the basis of descriptions of services provided. TPs for studies were aligned with a common functional-level framework, converted to a one-month time period, synthesized, and compared with theory-based expectations. Meta-regression was employed to explore associations between TPs and characteristics of service recipients and studies.
  
  
  
  R systems performed better than M and B systems. However, M systems did not perform better than B systems. All systems showed negative as well as positive TPs. For approximately one-third of synthesized TPs, substantial interstudy heterogeneity was noted. Associations were found between TPs and service recipient and study variables Conclusions: Conceptualizing systems as B, M, and R has potential for improving scientific understanding and systems planning. R systems appear more effective than B and M systems, although there is no "magic bullet" system for all service recipients. Interstudy heterogeneity indicates need for common approaches to reporting service recipient states, time periods for TPs, service recipient attributes, and service system characteristics. TPs found should be used in Markov simulations to project system effectiveness and costs of over time.
authors.affiliation: Dr. Leff and Dr. Chow are with the Department of Psychiatry, Cambridge Health Alliance-Harvard Medical School, Cambridge, Massachusetts. Dr. Leff is also with the Human Services Research Institute, Cambridge, Massachusetts. Dr. Graves is with the Department of Management Science, Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts. Send correspondence to Dr. Chow (e-mail: c.chow@snhu.edu ).
authors.forename: Hugh Stephen
authors.initials: HS
authors.lastname: Leff
authors.affiliation: Dr. Leff and Dr. Chow are with the Department of Psychiatry, Cambridge Health Alliance-Harvard Medical School, Cambridge, Massachusetts. Dr. Leff is also with the Human Services Research Institute, Cambridge, Massachusetts. Dr. Graves is with the Department of Management Science, Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts. Send correspondence to Dr. Chow (e-mail: c.chow@snhu.edu ).
authors.forename: Clifton M
authors.initials: CM
authors.lastname: Chow
authors.affiliation: Dr. Leff and Dr. Chow are with the Department of Psychiatry, Cambridge Health Alliance-Harvard Medical School, Cambridge, Massachusetts. Dr. Leff is also with the Human Services Research Institute, Cambridge, Massachusetts. Dr. Graves is with the Department of Management Science, Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts. Send correspondence to Dr. Chow (e-mail: c.chow@snhu.edu ).
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Graves
mesh_terms: D006801:Humans; D008390:Markov Chains; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*
keywords: Mental health systems/hospitals; Outpatient treatment; Systems theory