Academic-Community EPINET (AC-EPINET): Mitigating Barriers to Care

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Study Abstract Comprehensive specialty care programs for young people in the initial phases of psychotic disorders, such as Coordinated Specialty Care (CSC), deliver superior clinical outcomes compared to usual care. Challenges associated with CSC that, if addressed, would further enhance its effectiveness include the utilization of health care data to continuously improve clinical decision-making and services delivery. In addition, innovative interventions that strengthen treatment engagement and improve key outcomes, such as hospitalization rates, would also enhance CSC effectiveness. The Academic-Community EPINET (AC-EPINET) will address these challenges through a network of six early intervention (“spoke”) sites connected through advanced informatics to a central hub. Our network will implement a Learning Healthcare System (LHS), embedded in the everyday workflow of spoke clinics, to identify performance gaps, drive continuous quality improvement and enable practice-based research. The LHS will utilize the EPINET common assessment battery and CSC-ONE will serve as the informatics platform. It passively extracts data from electronic health records to minimize dual entry and supports a culture of measurement and continuous improvement. Dashboard displays of outcomes permit real-time comparisons within and across spoke clinics, driving patient outcomes towards international best practice standards, while maintaining critical privacy standards. Our six clinical spoke sites share the following: 1) established early psychosis programs following the CSC model; 2) deep expertise in data collection, assessments, and clinical trial research to enhance the conduct of the pilot research study; 3) community-based, “real-world” early psychosis clinics enrolling underserved populations, including urban poor and rural populations; and 4) strong interests and experience with telehealth (TH). The central hub will provide study governance, oversight, data management, training, data transfer to the NDCC. The leadership team has deep expertise in comparative effectiveness trials, TH services delivery, informatics, and large data set outcomes analytics. Thus, the AC-EPINET is well positioned to achieve data-driven, improved clinical services through the use of a common assessment battery. Moreover, we will assess the effectiveness of CSC treatment delivered through telehealth (CSC-TH) compared to standard, clinic-based CSC (CSC-SD) to improve engagement and hospitalization rates in a 12-month, randomized trial. Several studies have demonstrated that TH treatment enhances engagement by overcoming barriers, such as long travel commutes to clinics, unavailability of reliable transportation for clinic appointments, stigma associated with receiving care in psychiatric clinics, and inconveniences adapting to inflexible service schedules and workflow patterns. In addition, TH treatment has shown advantages for decreasing hospitalization rates, which is supported by our preliminary studies. Combined with the LHS, the TH intervention has the potential to enhance the effectiveness of AC-EPINET to improve the lives and outcomes of individuals with early psychosis.