California Collaborative Network to Promote Data Driven Care and Improve Outcomes in Early Psychosis (EPI-CAL)

加州合作网络促进数据驱动护理并改善早期精神病的结果 (EPI-CAL)

• 批准号: 10015341
• 负责人: Tara Ann Niendam
• 金额: $ 157.92万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-10 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10015341
• 关键词: Address; Adoption; California; Caring; Client; Client satisfaction; Clinic; Clinical; Collaborations; Communities; Custom; Data; Data Analyses; Development; Dimensions; Economics; Effectiveness; Enrollment; Ensure; Equipment and supply inventories; Evaluation; Family member; Feedback; Funding; Health; Health Technology; Individual; Intervention; Maintenance; Measures; Monitor; National Institute of Mental Health; Outcome; Participant; Provider; Psychometrics; Psychotic Disorders; Quality of life; Reference Standards; Reporting; Research; Schizophrenia; Severities; Site; Standardization; Symptoms; Target Populations; Technology; Testing; Time; Training; Universities; Validation; Work; base; care outcomes; care providers; clinical care; community setting; dashboard; data de-identification; data infrastructure; evidence base; experience; first episode psychosis; formative assessment; health data; implementation science; improved; improved outcome; innovation; mHealth; medical specialties; novel; programs; psychotic symptoms; sound; support network; tool; treatment choice; treatment planning; treatment program

Project Summary A prolonged first episode of psychosis (FEP) without adequate treatment is the most consistent predictor of poor clinical and functional outcomes1, poor health outcomes2 and significant economic burden3. Team-based “coordinated specialty care” (CSC)4 for early psychosis (EP) has established effectiveness in promoting clinical and functional recovery5 . EP treatment programs have expanded rapidly with increased funding across the US without formal coordination of training or implementation. While EP programs share many features, the lack of state and national coordination and data infrastructure limits the capacity for large-scale evaluation or accelerated dissemination of best practices6. Based on prior collaborations with 30 California (CA) EP programs and experiences using mobile health (MOBI mHealth) technology to measure individual outcomes in EP care, the UC Davis (UCD) team is uniquely poised to create EPI-CAL, a CA network that will contribute systematically collected outcomes data on over 1000 FEP clients per year, from 6 community and 6 university EP clinics, to a national EP network supported by the NIMH EPINET program. Building on our prior work evaluating CA EP programs, EPI-CAL programs will participate in a formative evaluation in Year 1 to define core EP clinical features, intervention targets, and outcomes needed to harmonize network input. A “core battery” based on current measures collected at the sites, the PhenX toolkit7 and expanded to cover all critical domains, will be installed across the network in Year 2. Core client outcomes and metrics of data use for treatment decisions will be collected using the custom MOBI mHealth data network at the client, program, and state level to allow easy data analysis, interpretation and dissemination. Training and ongoing monitoring will be provided at all EPI-CAL sites to ensure appropriate implementation. EPI-CAL will contribute de-identified data to the national coordinating hub. Using the RE-AIM implementation science framework8,9, we will systematically evaluate the impact of MOBI on EP programs across 5 dimensions: reach, efficacy, adoption, implementation, and maintenance (see Figure 1). To demonstrate the network’s research capacity, in the R34 component of this application, we propose to develop and validate a measure of the Duration of Untreated Psychosis (DUP) that is feasible for use in community settings and psychometrically sound. Although DUP is a significant predictor of both short-term CSC treatment response5 and long-term outcomes10 for FEP, no measure currently exists that has been rigorously validated and is feasible for use by community providers7,11. We will utilize stakeholder feedback (clients, family members, academic experts and CSC staff) to develop a tool with standardized DUP definitions that includes anchored assessment of psychosis onset and start of treatment. Developing such a tool will allow standardized assessment of this critical moderator of CSC outcomes across the entire EPINET.

项目摘要 长期的首发精神病(FEP)没有得到适当的治疗是最一致的预测因素 临床和功能预后差1、健康状况差2和严重的经济负担3。以团队为基础 早期精神病(EP)的协调专科护理(CSC)4在促进临床方面取得了成效 和功能恢复。随着全美资金的增加，EP治疗项目迅速扩大 没有对培训或实施进行正式协调。虽然EP程序有许多共同的特点，但缺乏 国家和国家的协调和数据基础设施限制了大规模评估或 加速传播最佳做法6。基于之前与30个加州(CA)EP的合作 使用移动医疗(MOBI MHealth)技术衡量个人成果的计划和体验 EP CARE，加州大学戴维斯分校(UCD)团队准备创建EPI-CAL，这是一个将做出贡献的CA网络 每年系统地收集来自6个社区和6所大学的1000多名FEP客户的结果数据 EP诊所向由NIMH EPINET计划支持的全国EP网络提供援助。建立在我们先前工作的基础上 评估CA EP计划，EPI-CAL计划将在一年级参与形成性评估，以确定 协调网络输入所需的核心EP临床特征、干预目标和结果。一个“核心” 基于在现场收集的电流测量，PhenX工具包7并扩展到涵盖所有关键的 域，将在第2年内通过网络安装。核心客户端结果和数据使用指标 治疗决定将使用客户端、计划和定制MOBI mHealth数据网络收集 在国家一级，使数据分析、解释和传播变得容易。培训和持续监测将 在所有EPI-CAL站点提供，以确保适当的实施。EPI-CAL将有助于消除身份识别 将数据发送到国家协调中心。利用RE-AIM实施科学框架8，9，我们将 从5个维度系统评估MOBI对EP计划的影响：覆盖范围、有效性、采用率、 实施和维护(参见图1)。为了展示网络的研究能力，在R34 组件，我们建议开发并验证未治疗持续时间的测量方法 精神病(DUP)，在社区环境中使用是可行的，并且心理测量健康。虽然DUP是一个 FEP的短期CSC治疗反应和长期结果的显著预测指标10，NO 目前存在的措施已经过严格验证，可供社区提供者使用。 我们将利用利益相关者的反馈(客户、家庭成员、学术专家和CSC工作人员)来制定 具有标准化DUP定义的工具，其中包括对精神病开始和开始的固定评估 治疗。开发这样的工具将允许对CSC的这一关键主持人进行标准化评估 整个EPINET的结果。