Young adults, health care use and psychosis

项目总结 青壮年是精神分裂症最常见的发病时期。在首发精神病(FEP)期间及早发现并接受综合治疗可改善康复、结局和复发率。然而，美国的研究一直发现，未经治疗的精神病平均持续时间超过一年。识别和治疗这一弱势群体的一个关键障碍可能是支离破碎的美国医疗体系。年轻人通常没有什么资源和途径有资格参加公共项目，这些项目帮助个人驾驭可能为患有SMI的个人提供的一系列复杂的医疗和其他服务。最近在与FEP治疗相关的证据基础以及如何最好地提供这些治疗方面的改进，有可能导致对这一弱势群体的更早发现和改善结果。然而，目前还不清楚这些证据基础上的变化是否已经扩散到临床实践中。新出现的精神健康障碍患者可能会从这些变化中获得有意义的好处，包括更短的未经治疗的精神病病程、更适当的药物类型和剂量、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，通过研究不同年龄段的年轻人的预后趋势，我们的目的是：目的1：检查住院和急诊科治疗精神病的年轻人是否以及如何随着时间的推移而发生变化，并探索任何变化的决定因素；目标2：检查基于医院的精神病治疗的再次入院是否以及如何随着时间的推移发生变化，并探索任何变化的决定因素；目标3：检查被诊断为精神病的年轻人因可能的自杀企图而去急诊科就诊的比率是否以及如何随着时间的变化而发生变化，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)：描述为患有FEP的年轻人在公共计划福利方面的州和计划创新。对于目标1-3，我们将使用国家和州的住院和急诊科使用数据来比较不同年龄和不同州队列中的个人结果的趋势。对于目标4，我们将对来自各州、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和其他新出现的SMI的脆弱个人有关的创新。精神病发作的时候，个人正在上学，进入劳动力大军，组建家庭，或做出其他选择，将产生终生后果。最近的科学工作为改善对这一弱势群体的护理提供了机会，可能会导致终身功能的增加。这项工作将与董事和其他利益相关者相关，他们有兴趣更好地了解为新兴SMI患者提供更全面和创新的服务的好处。

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.