Academic-Community EPINET (AC-EPINET): Mitigating Barriers to Care

研究摘要 为精神障碍初期的年轻人提供全面的特殊护理方案，例如 协调专科护理(CSC)，与常规护理相比，提供更好的临床结果。挑战 与CSC有关的问题，如果得到解决，将进一步提高其有效性，包括利用卫生 护理数据，以持续改善临床决策和服务提供。此外，创新 加强治疗参与度和改善关键结果的干预措施，如住院率， 也将提高公务员制度委员会的效力。学术社区EPINET(AC-EPINET)将解决这些问题 通过高级信息学连接的六个早期干预(“发言”)站点的网络带来的挑战 到一个中心枢纽。我们的网络将实施学习医疗系统(LHS)，嵌入 分支诊所的日常工作流程，以确定绩效差距，推动持续质量改进和 开展以实践为基础的研究。LHS将使用EPINET公共评估电池和CSC-One 将作为信息学平台。它被动地从电子健康记录中提取数据，以最大限度地减少双重 加入并支持衡量和持续改进的文化。结果的仪表板显示 允许在分支诊所内和分支诊所之间进行实时比较，推动患者结果走向国际 最佳实践标准，同时保持严格的隐私标准。我们的六个临床发言站点共享 以下内容：1)遵循CSC模式建立早期精神病计划；2)在数据方面拥有深厚的专业知识 收集、评估和临床试验研究，以加强先导研究研究的开展；3) 以社区为基础的“真实世界”早期精神病诊所招募服务不足的人群，包括城市贫困人口 和农村人口；4)对远程保健有浓厚的兴趣和经验(TH)。中央枢纽将提供 研究治理、监督、数据管理、培训、向国家发改委传输数据。领导班子已经 在比较有效性试验、TH服务交付、信息学和大型数据集方面拥有深厚的专业知识 结果分析。因此，AC-EPINET处于有利地位，可以实现数据驱动的、改进的临床服务 通过使用一个共同的评估小组。此外，我们还将评估CSC的有效性 通过远程医疗(CSC-TH)提供的治疗与基于临床的标准CSC(CSC-SD)相比 在为期12个月的随机试验中，提高参与率和住院率。几项研究已经 证明了这种治疗通过克服障碍，如长途旅行通勤，提高了参与度 对于诊所来说，无法获得可靠的就诊交通工具，与接受护理相关的耻辱 在精神科诊所，以及适应僵化的服务时间表和工作流程模式的不便。在……里面 此外，TH治疗在降低住院率方面显示出优势，这一点得到了我们的支持 初步研究。与LHS相结合，TH干预有可能提高有效性 AC-EPINET用于改善早期精神病患者的生活和预后。

Study Abstract Comprehensive specialty care programs for young people in the initial phases of psychotic disorders, such as Coordinated Specialty Care (CSC), deliver superior clinical outcomes compared to usual care. Challenges associated with CSC that, if addressed, would further enhance its effectiveness include the utilization of health care data to continuously improve clinical decision-making and services delivery. In addition, innovative interventions that strengthen treatment engagement and improve key outcomes, such as hospitalization rates, would also enhance CSC effectiveness. The Academic-Community EPINET (AC-EPINET) will address these challenges through a network of six early intervention (“spoke”) sites connected through advanced informatics to a central hub. Our network will implement a Learning Healthcare System (LHS), embedded in the everyday workflow of spoke clinics, to identify performance gaps, drive continuous quality improvement and enable practice-based research. The LHS will utilize the EPINET common assessment battery and CSC-ONE will serve as the informatics platform. It passively extracts data from electronic health records to minimize dual entry and supports a culture of measurement and continuous improvement. Dashboard displays of outcomes permit real-time comparisons within and across spoke clinics, driving patient outcomes towards international best practice standards, while maintaining critical privacy standards. Our six clinical spoke sites share the following: 1) established early psychosis programs following the CSC model; 2) deep expertise in data collection, assessments, and clinical trial research to enhance the conduct of the pilot research study; 3) community-based, “real-world” early psychosis clinics enrolling underserved populations, including urban poor and rural populations; and 4) strong interests and experience with telehealth (TH). The central hub will provide study governance, oversight, data management, training, data transfer to the NDCC. The leadership team has deep expertise in comparative effectiveness trials, TH services delivery, informatics, and large data set outcomes analytics. Thus, the AC-EPINET is well positioned to achieve data-driven, improved clinical services through the use of a common assessment battery. Moreover, we will assess the effectiveness of CSC treatment delivered through telehealth (CSC-TH) compared to standard, clinic-based CSC (CSC-SD) to improve engagement and hospitalization rates in a 12-month, randomized trial. Several studies have demonstrated that TH treatment enhances engagement by overcoming barriers, such as long travel commutes to clinics, unavailability of reliable transportation for clinic appointments, stigma associated with receiving care in psychiatric clinics, and inconveniences adapting to inflexible service schedules and workflow patterns. In addition, TH treatment has shown advantages for decreasing hospitalization rates, which is supported by our preliminary studies. Combined with the LHS, the TH intervention has the potential to enhance the effectiveness of AC-EPINET to improve the lives and outcomes of individuals with early psychosis.