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

项目总结/摘要 对于RAISE计划，我们首先开发了协调专业护理（CSC）的NAVIGATE模型， 支持EPINET的目标，即促进基于测量的护理和共享 治疗决定。为了实现EPINET改善治疗的目标，让所有站点提供治疗， 使用相同的模型具有明显的优势。因此，我们在4个州的11个NAVIGATE站点进行了合作， 使我们能够应对不同地区的挑战并找到不依赖于 一个国家的环境和支持。根据我们的经验培训NAVIGATE网站和分析 根据RAISE-ETP数据，我们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，为所有参与者增加了NAVIGATE护理的初始方法， 增强版的NAVIGATE（电子导航）。第二，三个研究项目的目标是关键的结合点， CSC护理。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，中位DUP为 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 当有人搜索互联网时，会出现响应特定术语的信息。我们期望这将 增加来我们诊所就诊的DUP较短的年轻人的数量。研究2进一步探讨 减少住院。即使有CSC，大约三分之一的人将在2年内住院， 药物依从性差可能导致住院治疗。直接观察治疗可以大大提高 提高依从性并减少住院治疗。我们将研究一套独特的直接观察方法 作为智能手机上的应用程序提供，以支持遵守。在一项随机试验中，我们将比较 对常规E-NAVIGATE进行干预，以提高依从性并减少住院治疗。研究3旨在 识别脱离接触风险高的E-NAVIGATE参与者，并进行干预， 防止/延迟脱离，因为即使使用CSC，30-50%的参与者也会脱离治疗 两年内。我们将比较减少治疗负担的E-NAVIGATE的互联网交付版本 常规的临床策略来防止脱离。 我们将在我们的RAISE-ETP和后ETP经验的基础上，建立一个独特的网络， 不断发展的CSC，根据经验反馈和专用信息平台进行更改。 研究，旨在推广不仅对我们的网络，但CSC的做法更广泛，将设置 下一代CSC部署的阶段。

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.