Early-phase Schizophrenia: Practice-based Research to Improve Treatment Outcomes (ESPRITO)

项目摘要/摘要 对于RAISE计划，我们开发了第一个协调专科护理(CSC)的导航模型 支持EPINET促进基于测量的护理和共享的目标的发作性精神病 治疗决定。为了达到EPINET改善治疗的目标，使所有地点都提供治疗 使用相同的模型具有明显的优势。因此，我们在4个州部署了11个导航站点， 使我们能够应对不同地区的挑战，并找到不依赖于 环境和单一国家的支持。根据我们的经验，培训导航网站和分析 根据RAISE-ETP数据，我们已经确定了改善服务的目标。我们的具体改进目标 分为两类。首先，添加初始方法以导航所有参与者的护理，以提供 增强版本的导航(电子导航)。第二，三个研究项目针对的是 CSC关怀。研究1旨在减少未经治疗的精神病(DUP)的持续时间。在RAISE-ETP中位数DUP是 74周，对生活质量和症状有显著影响。我们将研究定向广告的效果 当有人在互联网上搜索时，这些词会针对特定的术语出现。我们预计这将是 增加来我们诊所就诊的较短DUP的年轻人数量。研究2进一步解决问题 减少住院次数。即使有了CSC，也有大约三分之一的人将在两年内住院， 不遵守药物治疗可能会导致住院治疗。对治疗的直接观察可以实质上 提高依从性，减少住院。我们将研究一套独特的直接观察方法 在智能手机上以应用程序的形式提供，以支持遵守。在一项随机试验中，我们将比较这一点 对通常的电子导航进行干预，以提高依从性并减少住院。研究3旨在 确定高风险脱离的电子导航参与者，并进行干预，以便 防止/推迟脱离治疗，因为即使在CSC的情况下，30%-50%的参与者也会脱离治疗 在两年内。我们将比较互联网上提供的减轻治疗负担的E-Navise版本 常规的临床策略，以防止脱离。 我们将在RAISE-ETP和POST-ETP经验的基础上构建一个独特的网络，以提供 根据经验反馈和专用信息学平台不断发展变化的CSC。 研究，旨在不仅适用于我们的网络，而且适用于更广泛的CSC实践，将设置 为下一代CSC部署做好准备。

PROJECT SUMMARY/ABSTRACT For the RAISE initiative, we developed the NAVIGATE model of coordinated specialty care (CSC) for first episode psychosis which supports the EPINET goal of furthering measurement-based care and shared treatment decisions. To meet the EPINET goal of improving treatment, having all sites providing treatment using the same model has distinct advantages. Therefore, we have engaged 11 NAVIGATE sites in 4 states, enabling us to address challenges in different regions and find solutions that are not dependent on the environment and support of a single state. Based on our experience training NAVIGATE sites and analyses of RAISE-ETP data, we have identified targets for improvement of services. Our specific targets for improvement divide into two categories. First, initial approaches added to NAVIGATE care for all participants to provide an enhanced version of NAVIGATE (E-NAVIGATE). Second, three research projects target critical junctures in CSC care. Study 1 aims to reduce duration of untreated psychosis (DUP). In RAISE-ETP median DUP was 74 weeks and had a significant impact on quality of life and symptoms. We will study the effect of targeted ads that appear in response to specific terms when someone searches the internet. We expect that this will increase the number of young people who will come to our clinics with shorter DUP. Study 2 addresses further reduction of hospitalization. Even with CSC, approximately one third will be hospitalized within 2 years and poor adherence to medication can lead to hospitalization. Direct observation of treatment can substantially improve adherence and reduce hospitalization. We will study a unique suite of methods for direct observation delivered as an app on a smart phone to support adherence. In a randomized trial we will compare this intervention to usual E-NAVIGATE to improve adherence and reduce hospitalization. Study 3 is designed to identify E-NAVIGATE participants who are at high risk for disengagement, and to intervene in order to prevent/delay disengagement because even with CSC, 30-50% of participants will disengage from treatment within 2 years. We will compare an internet delivered version of E-NAVIGATE that reduces treatment burden to usual clinical strategies to prevent disengagement. We will build upon our RAISE-ETP and post-ETP experience to build a unique network that will deliver an evolving CSC that changes based upon feedback from experience and a dedicated informatics platform. Research, designed to be generalizable not only to our network but to CSC practice more broadly, will set the stage for the next generation of CSC deployment.