Young adults, health care use and psychosis

项目摘要 青年期是精神分裂症最常见的发病期。在精神病首次发作（FEP）期间早期识别和接受综合治疗可改善恢复，结果和复发率。然而，美国的研究一致发现，未经治疗的精神病的平均持续时间超过一年。对这一弱势群体的识别和治疗的一个关键障碍可能是美国支离破碎的医疗保健系统。年轻人通常没有什么资源和途径来获得公共计划的资格，这些计划帮助个人在复杂的医疗和其他服务中导航，这些服务可能适用于患有SMI的个人。最近与FEP治疗相关的证据基础的改进以及如何最好地提供这些治疗有可能导致早期检测和改善这一脆弱人群的结果。然而，目前尚不清楚这些证据基础的变化是否已扩散到临床实践中。患有新出现的精神健康障碍的个人可能会从这些变化中获得有意义的好处，包括未经治疗的精神病持续时间更短，更合适的药物类型和剂量，由更合适的合格提供者进行治疗，支持服务和一般医疗条件的治疗。在这项研究中，通过检查不同年龄的年轻人的结局趋势，我们的目标是：目标1：检查精神病患者的住院和急诊治疗是否以及如何随着时间的推移而变化，并探索任何变化的决定因素;目标2：检查精神病医院治疗的重新入院是否以及如何随着时间的推移而变化，并探索任何变化的决定因素;目标3：检查是否以及如何在诊断为精神病的年轻人中，因可能的自杀企图而到急诊室就诊的比率随着时间的推移而发生变化，并探索任何变化的决定因素。此外，我们的目标是：目标4（探索性）：描述国家和计划创新的公共计划福利的年轻人与FEP。对于目标1-3，我们将使用关于住院和急诊使用的国家和州数据，比较各州不同年龄和队列的个人结局趋势。对于目标4，我们将与来自各州、医疗服务提供者和健康计划的代表进行定性访谈，以记录与识别和治疗患有FEP和其他新兴SMI的弱势个体相关的创新。精神病在个人上学、进入职场、组建家庭或做出其他影响一生的选择时发作。最近的科学工作提供了机会，以改善对这一弱势群体的照顾，可能导致终身功能的增加。这项工作将有助于董事和其他利益相关者更好地了解向新出现的SMI个人提供更全面和创新服务的好处。

PROJECT SUMMARY Young adulthood is the most common period of onset for schizophrenia. Early identification and receipt of comprehensive treatment during first episode psychosis (FEP) leads to improvements in recovery, outcome and relapse rates. Yet, US studies consistently find an average duration of untreated psychosis greater than one year. One critical barrier to identification and treatment for this vulnerable group may be the fragmented US health care system. Young adults typically have few resources and few paths to qualify for public programs that aid individuals in navigating the complex array of medical treatments and other services potentially available for individuals with SMI. Recent improvements in the evidence-base related to treatment for FEP and how best to deliver these treatments have the potential to lead to earlier detection and improved outcomes for this vulnerable population. Yet, it is not clear these changes in the evidence-base have diffused into clinical practice. Individuals with emerging mental health disorders may reap meaningful benefits from these changes, including shorter duration of untreated psychosis, more appropriate types and dose of medications, treatment by more appropriately qualified providers, support services and treatments for general medical conditions. In this study, by examining trends in outcomes among young adults of different ages, we aim to: Aim 1: Examine whether and how inpatient and emergency department treatment for young adults with psychosis has changed over time, and explore determinants of any changes; Aim 2: Examine whether and how re-admissions for hospital-based treatments for psychosis has changed over time, and explore determinants of any changes; Aim 3: Examine whether and how the rate of emergency department visits for likely suicide attempts among young adults with a diagnosis of psychosis has changed over time, and explore determinants of any changes. In addition, we aim to: Aim 4 (exploratory): Describe state and plan innovation in public program benefits for young adults with FEP. For aims 1-3, we will compare trends in outcomes among individuals of different ages and cohorts in various states using national and state data on hospital admissions and emergency department use. For aim 4 we will conduct qualitative interviews with representatives from states, providers and health plans to document innovations related to identification and treatment of vulnerable individuals with FEP and other emerging SMI. Psychosis strikes at a time when individuals are in school, entering the workforce, starting families, or making other choices with lifetime consequences. Recent scientific work offers opportunities to improve care for this vulnerable population, possibly resulting in lifetime increases in functioning. This work will be relevant to directors and other stakeholders interested in better understanding the benefits of providing more comprehensive and innovative services to individuals with emerging SMI.