Mobile After-Care Support Intervention for Patients with Schizophrenia following Hospitalization

精神分裂症和情感障碍与不成比例的高社会成本有关， 治疗、残疾和发病率/死亡率。患者不依从药物治疗和心理社会 治疗破坏了这些疾病的长期管理，使其难以实现改善 生活质量和最终康复。患者在治疗间隙和应对不良方面的风险特别高 在从住院治疗到门诊治疗的过渡时期。我们的长期目标是改善 精神病患者护理的连续性，支持更安全，更有效地从 从住院到门诊我们的目标是实现这一长期目标的下一步， 在我们以前资助的工作的基础上，是研究一种方法的可行性、可接受性和初步功效， 移动的设备交付的应用程序，称为移动的后续护理支持（MACS），以改善患者的自我应对， 住院后的药物治疗和预约依从性。我们假设MACS，一种反应- 自适应移动的应用程序使用精神病的辅助认知行为策略，将导致 自我应对和药物/预约依从性的目标机制的增加，这将产生 改善症状、继发功能和再住院率。因此，建立MACS 作为一个可行的连续治疗援助，在关键的几个月内立即出院将提供必要的 改善成人精神病患者预后的途径数据。本建议的目的是：（1）使用 通过进行初始开放试验（n=10）改进新移动的术后护理应用程序的迭代过程;以及（2） 进行一项MACS与移动的应用程序时间和注意力控制的初步随机对照试验（n = 50） 以检验其初步效果。在开放试验期间，我们还将从当地收集定性数据， 利益相关者（例如，患者，临床医生，管理人员），以改善干预准备 该项目的随机化阶段，并建立临床医生对从MACS接收临床数据的偏好。 样本将包括60例精神分裂症谱系障碍患者，在住院期间招募 精神病住院治疗，并过渡到当地社区精神卫生中心的门诊治疗。 患者将在出院后4个月内使用MACS，在此期间，我们将纵向评估他们的 使用和结果。这一办法的创新之处在于，它打破了现状， 风险和未充分研究的阶段，并通过实时提供简短的干预， 病人移动的手机上的应用程序。成功完成拟议的项目将大大有助于 关于MACS的可行性和可接受性及其对应对、治疗、 依从性和后续临床结局（症状、功能、再住院）。本项目的数据 将告知未来的大规模测试MACS作为一个简单的和潜在的传播工具，以帮助患者 因精神病住院后重返社区。

Schizophrenia and schizoaffective disorder are associated with disproportionately high societal costs related to treatment, disability, and morbidity/mortality. Patients' nonadherence to medications and psychosocial treatments undermine the long-term management of these illnesses, making it difficult to achieve improved quality of life and ultimate recovery. Patients are at particularly high risk of treatment gaps and poor coping during the transitional period from inpatient hospitalization to outpatient care. Our long-term goal is to improve the continuity of care for patients with psychosis by supporting a safer and more efficient transition from inpatient to outpatient services. Our objective, which is the next step in attaining this long-term goal and building on our previously funded work, is to examine the feasibility, acceptability, and preliminary efficacy of a mobile device-delivered app, called Mobile After-Care Support (MACS), to improve patients' self-coping and medication and appointment adherence following a hospitalization. We hypothesize that MACS, a response- adaptive mobile app using empirically-supported cognitive behavioral strategies for psychosis, will lead to increases in the target mechanisms of self-coping and medication/appointment adherence, which will produce improvements in symptoms, and secondarily functioning and rehospitalization rates. Thus, establishing MACS as a viable adjunctive treatment aid during the critical months immediately post-discharge will provide essential data on a pathway to improved outcomes in adults with psychosis. The aims of this proposal are: (1) to use an iterative process to refine a new mobile aftercare app by conducting an initial open trial (n=10); and (2) to conduct a pilot randomized controlled trial (n = 50) of MACS vs. a mobile app time and attention control condition to examine its preliminary effects. During the open trial, we also will collect qualitative data from local stakeholders (e.g., patients, clinicians, administrators) to improve the intervention in preparation for the randomized phase of the project and to establish clinicians' preferences for receiving clinical data from MACS. The sample will consist of 60 patients total with schizophrenia-spectrum disorders, recruited during an inpatient psychiatric hospitalization and transitioning to outpatient care at local community mental health centers. Patients will use MACS up to 4 months post-discharge, during which time we will longitudinally assess their usage and outcomes. The approach is innovative in that it departs from the status quo by targeting this high risk and understudied phase in the continuum of care and by delivering a brief intervention in real-time via an app on patients' mobile phones. Successful completion of the proposed project will contribute significant actionable data on the feasibility and acceptability of MACS and its initial effects on coping, treatment adherence, and subsequent clinical outcomes (symptoms, functioning, rehospitalization). Data from this project will inform the future large-scale testing of MACS as a simple and potentially disseminable tool to aid patients' re-entry into the community after being hospitalized for psychosis.