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减少美国未治疗精神病的持续时间（R01）项目名称：减少未治疗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，在美国，是否可以采用挪威成功的早期检测方法（TIPS），从而大大减少未治疗精神病的持续时间（DUP），并改善美国政策相关环境中现有的专业首发服务（FES）的结果。所提议的研究涉及一种准实验设计，其中一个提供FES的站点（STEP，纽黑文）将增加一个早期检测（ED）活动，以减少其集水区的DUP，而一个控制站点（PREP，波士顿）将继续提供同等的FES，而不提供ED。我们假设与通常的检测站点相比，早期检测站点的DUP将显着减少。此外，我们假设，与非ED部位相比，DUP的减少将转化为ED部位1年预后的改善，证明ED对已经建立和有效的FES的“附加价值”。DUP的主要结果将在两个地点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，并已在两个地点使用了5年。1年的结果将在两个地点进行测量，并将评估三个广泛的领域：1)临床状态：包括住院率和复发、自杀、攻击和症状量表；2)功能状态：包括工作能力或接受适龄教育的能力、社会功能和生活质量。3)成本：广义衡量，包括治疗和使用的社会和法医服务的成本。早期检测运动将包括针对患者和家庭的社会营销组成部分，以增加寻求帮助的行为，专业外展，以提高从地方机构转诊到STEP的速度，并使STEP诊所对转诊的快速反应运作，所有这些都是为了尽量减少DUP。DUP的分析将集中在dpd3个月到达每个FES的比例的主要结果上。对1年结果的分析将集中在每个地点从事职业的比例上。

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.