Early-phase Schizophrenia: Practice-based Research to Improve Treatment Outcomes (ESPRITO)

早期精神分裂症：基于实践的研究以改善治疗结果（ESPRITO）

• 批准号: 10171918
• 负责人: JOHN M KANE
• 金额: $ 148.51万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-22 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10171918
• 关键词: Address; Adherence; Advanced Development; Antipsychotic Agents; Assessment tool; Biological Models; Caring; Categories; Cellular Phone; Clinic; Clinical; Clinical Services; Code; Cognitive; Collection; Common Data Element; Communities; Consensus; Data; Data Coordinating Center; Data Set; Devices; Education; Electronic Health Record; Emergency department visit; Environment; Family; Feedback; Florida; Fostering; Funding; Funding Opportunities; Goals; Grant; Health; Health system; Hospitalization; Individual; Informatics; Internet; Intervention; Lead; Leadership; Learning; Link; Manuals; Measurement; Mental Health; Methods; Michigan; Modeling; Monitor; Oklahoma; Oral; Outcome; Outcome Assessment; Participant; Patients; Performance; Pharmaceutical Preparations; Phase; Population; Positioning Attribute; Practice based research; Psychoses; Psychotic Disorders; Quality of life; Recovery; Reporting; Research; Research Design; Research Project Grants; Schizophrenia; Schools; Scientific Advances and Accomplishments; Self Assessment; Services; Signal Transduction; Site; South Carolina; Support System; Supported Employment; Symptoms; System; Time; Training; Trauma; Treatment outcome; Work; barrier to care; base; comparison intervention; design; expectation; experience; first episode psychosis; flexibility; high risk; implementation design; improved; improved outcome; medical specialties; medication administration; medication compliance; member; next generation; premature; prevent; programs; psychoeducation; psychotic symptoms; randomized trial; resilience; response; smartphone Application; social media; standard measure; substance use; tool

PROJECT SUMMARY/ABSTRACT For the RAISE initiative, we developed the NAVIGATE model of coordinated specialty care (CSC) for first episode psychosis which supports the EPINET goal of furthering measurement-based care and shared treatment decisions. To meet the EPINET goal of improving treatment, having all sites providing treatment using the same model has distinct advantages. Therefore, we have engaged 11 NAVIGATE sites in 4 states, enabling us to address challenges in different regions and find solutions that are not dependent on the environment and support of a single state. Based on our experience training NAVIGATE sites and analyses of RAISE-ETP data, we have identified targets for improvement of services. Our specific targets for improvement divide into two categories. First, initial approaches added to NAVIGATE care for all participants to provide an enhanced version of NAVIGATE (E-NAVIGATE). Second, three research projects target critical junctures in CSC care. Study 1 aims to reduce duration of untreated psychosis (DUP). In RAISE-ETP median DUP was 74 weeks and had a significant impact on quality of life and symptoms. We will study the effect of targeted ads that appear in response to specific terms when someone searches the internet. We expect that this will increase the number of young people who will come to our clinics with shorter DUP. Study 2 addresses further reduction of hospitalization. Even with CSC, approximately one third will be hospitalized within 2 years and poor adherence to medication can lead to hospitalization. Direct observation of treatment can substantially improve adherence and reduce hospitalization. We will study a unique suite of methods for direct observation delivered as an app on a smart phone to support adherence. In a randomized trial we will compare this intervention to usual E-NAVIGATE to improve adherence and reduce hospitalization. Study 3 is designed to identify E-NAVIGATE participants who are at high risk for disengagement, and to intervene in order to prevent/delay disengagement because even with CSC, 30-50% of participants will disengage from treatment within 2 years. We will compare an internet delivered version of E-NAVIGATE that reduces treatment burden to usual clinical strategies to prevent disengagement. We will build upon our RAISE-ETP and post-ETP experience to build a unique network that will deliver an evolving CSC that changes based upon feedback from experience and a dedicated informatics platform. Research, designed to be generalizable not only to our network but to CSC practice more broadly, will set the stage for the next generation of CSC deployment.

项目摘要/摘要 为了提高主动权，我们开发了第一个协调专业护理（CSC）的导航模型 情节精神病支持基于测量的护理并共享的Epiatet目标 治疗决定。为了满足改善治疗的日期目标，让所有网站提供治疗 使用相同的模型具有不同的优势。因此，我们在4个州订婚了11个导航站点， 使我们能够应对不同地区的挑战，并找到不依赖于该地区的解决方案 环境和单一状态的支持。根据我们的经验培训导航站点和分析 提高ETP数据，我们已经确定了改善服务的目标。我们改进的具体目标 分为两类。首先，为所有参与者提供护理的初步方法，以提供 增强版本的导航（e-navigate）。第二，三个研究项目针对关键关键时刻 CSC护理。研究1旨在减少未经治疗的精神病（DUP）的持续时间。在加里 - ETP中间的DUP是 74周，对生活质量和症状产生了重大影响。我们将研究目标广告的效果 当有人搜索互联网时，这是对特定术语的响应。我们希望这将 增加将以较短的DUP来到我们诊所的年轻人的数量。研究2进一步解决 减少住院。即使使用CSC，大约三分之一也将在2年内住院 对药物的依从性不佳会导致住院。直接观察治疗可以大大观察 提高依从性并减少住院。我们将研究独特的直接观察方法 在智能手机上作为应用程序交付以支持依从性。在随机试验中，我们将比较 干预通常的电子服务，以提高依从性并减少住院。研究3旨在 识别有高度脱离接触风险的参与者，并进行干预 防止/延迟脱离接触，因为即使使用CSC，也有30％至50％的参与者将脱离治疗 在2年内。我们将比较互联网交付的电子窃听版本，以减轻治疗负担 对于通常的临床策略来防止脱离接触。 我们将建立我们的加薪ETP和ETP后的经验，以建立一个独特的网络，该网络将提供一个 不断发展的CSC，该CSC会根据经验的反馈和专门的信息平台的反馈而变化。 研究不仅可以推广到我们的网络，而且可以更广泛地进行CSC练习，这将设定 下一代CSC部署的阶段。