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

早期精神分裂症：基于实践的研究以改善治疗结果（ESPRITO）

• 批准号: 10624900
• 负责人: JOHN M KANE
• 金额: $ 148.33万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-22 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10624900
• 关键词: Address; Adherence; Advanced Development; Antipsychotic Agents; Assessment tool; Biological Models; Caring; Categories; Cellular Phone; Certification; Clinic; Clinical; Clinical Services; Cognitive; Collection; Common Data Element; Communities; Consensus; Coordinated Specialty Care; Data; Data Coordinating Center; Data Set; Dedications; Devices; Education; Emergency department visit; Environment; Family; Feedback; Florida; Fostering; Funding; Funding Opportunities; Goals; Grant; Health; Health system; Hospitalization; Individual; Informatics; Internet; Intervention; Leadership; Learning; Link; Manuals; Measurement; Mental Health; Methods; Michigan; Modeling; Monitor; Oklahoma; Oral; Outcome; Outcome Assessment; Participant; Patients; Performance; Persons; Pharmaceutical Preparations; Phase; Population; Positioning Attribute; Practice based research; Psychoses; Psychotic Disorders; Quality of life; Recovery; Reporting; Research; Research Project Grants; Schizophrenia; Schools; Scientific Advances and Accomplishments; Self Assessment; Services; Signal Transduction; Site; South Carolina; Support System; Supported Employment; Symptoms; System; Time; Training; Trauma; Treatment outcome; Work; barrier to care; comparison intervention; data integration; design; duration of untreated psychosis; electronic health record system; expectation; experience; first episode psychosis; flexibility; high risk; implementation design; improved; improved outcome; medication administration; medication compliance; member; next generation; premature; prevent; programs; psychoeducation; psychoeducational; psychotic symptoms; randomized trial; resilience; response; scientific hub; smartphone application; social media; standard measure; substance use; tool

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.

项目总结/文摘