Mobile After-Care Support Intervention for Patients with Schizophrenia following Hospitalization

精神分裂症和分裂情感障碍与不成比例的高社会成本有关 治疗、残疾和发病率/死亡率。患者不坚持服药与心理社会 治疗破坏了对这些疾病的长期管理，使得情况很难得到改善 生活质量和最终康复。患者面临治疗缺口和应对能力差的风险特别高。 在住院向门诊过渡期间。我们的长期目标是改进 通过支持更安全和更有效的过渡，为精神病患者提供连续性护理 住院病人转门诊服务。我们的目标，这是实现这个长期目标的下一步， 在我们之前资助的工作的基础上，将检查一项 移动设备交付的应用程序，称为移动事后支持(Mac)，以改善患者的自我应对和 住院后的用药和预约遵守情况。我们假设Mac作为一种回应- 使用经验支持的认知行为策略治疗精神病的自适应移动应用程序将导致 增加自我应对和遵守服药/预约的目标机制，这将产生 症状、二次功能和再住院率的改善。因此，建立互委会 作为一种可行的辅助治疗手段，在紧接出院后的关键月份将提供必要的 有关改善成年精神病患者预后的途径的数据。这项建议的目的是：(1)使用一种 迭代过程，通过进行初步开放试验(n=10)来完善新的移动善后护理应用程序；以及(2) 进行Mac与移动应用时间和注意力控制的试点随机对照试验(n=50) 检查其初步效果的条件。在公开试验期间，我们还将从当地收集定性数据 利益相关者(例如，患者、临床医生、管理人员)改进干预措施，为 该项目的随机阶段，并建立临床医生从互委会接收临床数据的偏好。 样本将包括60名住院期间招募的精神分裂症谱系障碍患者。 精神科住院和在当地社区精神卫生中心过渡到门诊护理。 患者将在出院后4个月内使用Mac，在此期间，我们将纵向评估他们的 使用情况和结果。这种方法是创新的，因为它偏离了现状，将目标锁定在如此高的水平 连续护理中的风险和未得到充分研究的阶段，并通过 病人手机上的应用程序。拟议项目的成功完成将大大有助于 关于MACs的可行性和可接受性及其对应对和治疗的初步影响的可操作数据 依从性和随后的临床结果(症状、功能、再次住院)。此项目中的数据 将为未来的大规模Mac测试提供信息，作为一种简单且潜在的可传播工具，以帮助患者 因精神病住院后重新进入社区。

Schizophrenia and schizoaffective disorder are associated with disproportionately high societal costs related to treatment, disability, and morbidity/mortality. Patients' nonadherence to medications and psychosocial treatments undermine the long-term management of these illnesses, making it difficult to achieve improved quality of life and ultimate recovery. Patients are at particularly high risk of treatment gaps and poor coping during the transitional period from inpatient hospitalization to outpatient care. Our long-term goal is to improve the continuity of care for patients with psychosis by supporting a safer and more efficient transition from inpatient to outpatient services. Our objective, which is the next step in attaining this long-term goal and building on our previously funded work, is to examine the feasibility, acceptability, and preliminary efficacy of a mobile device-delivered app, called Mobile After-Care Support (MACS), to improve patients' self-coping and medication and appointment adherence following a hospitalization. We hypothesize that MACS, a response- adaptive mobile app using empirically-supported cognitive behavioral strategies for psychosis, will lead to increases in the target mechanisms of self-coping and medication/appointment adherence, which will produce improvements in symptoms, and secondarily functioning and rehospitalization rates. Thus, establishing MACS as a viable adjunctive treatment aid during the critical months immediately post-discharge will provide essential data on a pathway to improved outcomes in adults with psychosis. The aims of this proposal are: (1) to use an iterative process to refine a new mobile aftercare app by conducting an initial open trial (n=10); and (2) to conduct a pilot randomized controlled trial (n = 50) of MACS vs. a mobile app time and attention control condition to examine its preliminary effects. During the open trial, we also will collect qualitative data from local stakeholders (e.g., patients, clinicians, administrators) to improve the intervention in preparation for the randomized phase of the project and to establish clinicians' preferences for receiving clinical data from MACS. The sample will consist of 60 patients total with schizophrenia-spectrum disorders, recruited during an inpatient psychiatric hospitalization and transitioning to outpatient care at local community mental health centers. Patients will use MACS up to 4 months post-discharge, during which time we will longitudinally assess their usage and outcomes. The approach is innovative in that it departs from the status quo by targeting this high risk and understudied phase in the continuum of care and by delivering a brief intervention in real-time via an app on patients' mobile phones. Successful completion of the proposed project will contribute significant actionable data on the feasibility and acceptability of MACS and its initial effects on coping, treatment adherence, and subsequent clinical outcomes (symptoms, functioning, rehospitalization). Data from this project will inform the future large-scale testing of MACS as a simple and potentially disseminable tool to aid patients' re-entry into the community after being hospitalized for psychosis.