STEP-ED:Reducing Duration of Untreated Psychosis and its Impact in the U.S.

描述（由申请人提供）：本申请涉及资助机会：PAR-13-187减少美国未经治疗的精神病的持续时间（R 01）项目名称：STEP-ED：减少未经治疗的精神病的持续时间及其在美国的影响本研究的指导问题是，美国是否适应挪威（TIPS）采取的成功的早期发现方法在政策相关的美国环境中，可以大大减少未经治疗的精神病（DUP）的持续时间，并改善现有专业首发服务（FES）的结果。拟议的研究涉及一个准实验设计，其中一个网站，提供FES（STEP，纽黑文）将增加早期检测（艾德）运动，以减少DUP在其集水区，而控制网站（PREP，波士顿）将继续提供等效的FES没有ED。我们假设，DUP将显着减少在早期检测网站相比，通常的检测网站。此外，我们假设，与非艾德研究中心相比，DUP的降低将转化为艾德研究中心1年结局的改善，证明了艾德对已经建立和有效的FES的“附加值”。DUP的主要结局将在两个研究中心使用症状发作量表以一致的方式进行测量，该量表在评估早期症状方面是全面的，可靠的，并且已经在两个研究中心使用了5年。将在两个研究中心测量1年结果，并将评估三个广泛的领域：1）临床状态：包括住院率和复发率、自杀倾向、攻击性和症状量表; 2）功能状态：包括工作或参加适龄学校教育的能力、社会功能和生活质量; 3）费用：广泛测量，包括治疗费用和使用的社会和法医服务费用。早期发现运动将包括一个针对患者和家庭的社会营销部分，以增加寻求帮助的行为，专业外联，以提高当地机构向STEP转诊的速度，并使STEP诊所对转诊的快速反应发挥作用，所有这些都是为了尽量减少DUP。DUP分析将集中于DUP 3个月时到达各FES的比例的主要结局。1年结局的分析将集中在每个研究中心从事职业的比例上。

DESCRIPTION (provided by applicant): This application addresses the Funding Opportunity: PAR-13-187 Reducing the Duration of Untreated Psychosis in the United States (R01) Project Title: STEP-ED: Reducing Duration of Untreated Psychosis and its impact in the U.S. The guiding questions for this study are whether a U.S. adaptation of a successful early detection approach undertaken in Norway (TIPS) can substantially reduce the duration of untreated psychosis (DUP) and improve outcomes beyond existing specialty first-episode services (FES) in a policy-relevant U.S. setting. The proposed study involves a quasi-experimental design wherein one site that delivers FES (STEP, New Haven) will add an Early Detection (ED) campaign to reduce DUP in its catchment area, while a control site (PREP, Boston) will continue to deliver equivalent FES without ED. We hypothesize that DUP will be reduced significantly in the early detection site compared to the usual detection site. Also, we hypothesize that this reduction in DUP will translate into improvements 1 year outcomes at the ED site compared to the non-ED site, demonstrating the 'added value' of ED to already established and effective FES. The primary outcome of DUP will be measured in a consistent manner at both sites using the Symptom Onset Scale, which is comprehensive in assessing early symptoms, reliable and has been used by both sites for e5 years. 1 year outcomes will be measured at both sites and will assess three broad domains: 1) clinical status: including hospitalization rate and relapse, suicidality, aggression and symptom scales; 2) functional status: including ability to work or attend age- appropriate schooling, social functioning and quality of life and 3) costs: broadly measured to include costs of treatment and social and forensic services used. The Early Detection campaign will include a social marketing component targeting patients and families to increase help-seeking behavior, professional outreach to improve the rapidity of referral to STEP from local agencies and operationalizing rapid responsiveness of the STEP clinic to referrals, all with the aim of minimizing DUP. Analysis for DUP will be centered on the primary outcome of the proportion arriving to each FES with a DUPd3months. Analysis for 1-year outcomes will be centered on proportions who are vocationally engaged at each site.