STEP-ED:Reducing Duration of Untreated Psychosis and its Impact in the U.S.

说明(由申请人提供)：本申请针对的是资助机会：PAR-13-187缩短美国未治疗精神病的持续时间(R01)项目标题：STEP-ED：缩短未治疗精神病的持续时间及其在美国的影响本研究的指导性问题是，美国采用挪威成功的早期发现方法(TIPS)是否可以大幅缩短未治疗精神病(DUP)的持续时间，并在与政策相关的美国环境中改善现有的专业首发服务(FES)之外的结果。拟议的研究涉及一种准实验设计，其中一个提供FES的站点(纽黑文的STEP)将增加早期检测(ED)活动，以减少其集水区的DUP，而另一个对照站点(PREP，波士顿)将继续提供同等的FES，而不使用ED。我们假设，与通常的检测部位相比，早期检测部位的DUP将显着降低。此外，我们假设DUP的减少将转化为与非ED站点相比，ED站点的1年结果的改善，从而证明了ED对于已经建立和有效的FES的‘附加值’。DUP的主要结果将在两个地点使用症状始发量表以一致的方式衡量，该量表在评估早期症状方面全面、可靠，并已被两个地点使用了e5年。将在两个地点衡量一年的结果，并将评估三个广泛领域：1)临床状况：包括住院率和复发、自杀、攻击性和症状量表；2)功能状况：包括工作能力或接受适龄学校教育的能力、社会功能和生活质量；3)费用：广义衡量，包括治疗以及所使用的社会和法医服务的费用。早期发现活动将包括针对患者和家属的社会营销部分，以增加寻求帮助的行为，专业外联以提高从当地机构转诊到STEP的速度，以及实施STEP诊所对转诊的快速反应，所有这些都是为了最大限度地减少DUP。对DUP的分析将集中在每个FES达到DUPd3个月的比例的主要结果。对一年结果的分析将以每个地点从事职业活动的比例为中心。

DESCRIPTION (provided by applicant): This application addresses the Funding Opportunity: PAR-13-187 Reducing the Duration of Untreated Psychosis in the United States (R01) Project Title: STEP-ED: Reducing Duration of Untreated Psychosis and its impact in the U.S. The guiding questions for this study are whether a U.S. adaptation of a successful early detection approach undertaken in Norway (TIPS) can substantially reduce the duration of untreated psychosis (DUP) and improve outcomes beyond existing specialty first-episode services (FES) in a policy-relevant U.S. setting. The proposed study involves a quasi-experimental design wherein one site that delivers FES (STEP, New Haven) will add an Early Detection (ED) campaign to reduce DUP in its catchment area, while a control site (PREP, Boston) will continue to deliver equivalent FES without ED. We hypothesize that DUP will be reduced significantly in the early detection site compared to the usual detection site. Also, we hypothesize that this reduction in DUP will translate into improvements 1 year outcomes at the ED site compared to the non-ED site, demonstrating the 'added value' of ED to already established and effective FES. The primary outcome of DUP will be measured in a consistent manner at both sites using the Symptom Onset Scale, which is comprehensive in assessing early symptoms, reliable and has been used by both sites for e5 years. 1 year outcomes will be measured at both sites and will assess three broad domains: 1) clinical status: including hospitalization rate and relapse, suicidality, aggression and symptom scales; 2) functional status: including ability to work or attend age- appropriate schooling, social functioning and quality of life and 3) costs: broadly measured to include costs of treatment and social and forensic services used. The Early Detection campaign will include a social marketing component targeting patients and families to increase help-seeking behavior, professional outreach to improve the rapidity of referral to STEP from local agencies and operationalizing rapid responsiveness of the STEP clinic to referrals, all with the aim of minimizing DUP. Analysis for DUP will be centered on the primary outcome of the proportion arriving to each FES with a DUPd3months. Analysis for 1-year outcomes will be centered on proportions who are vocationally engaged at each site.