Young adults, health care use and psychosis

项目总结

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.