Young adults, health care use and psychosis

年轻人、医疗保健使用和精神病

• 批准号: 9028539
• 负责人: Susan H Busch
• 金额: $ 45.26万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9028539
• 关键词: Accident and Emergency department; Admission activity; Affect; Age; Age of Onset; Caring; Clinic; Clinical; Complement; Complex; Data; Diagnosis; Diffuse; Diffusion; Diffusion of Innovation; Disability Insurance; Dose; Early Diagnosis; Early Intervention; Early identification; Emergency department visit; Employee Strikes; Evidence based treatment; Family; Female; Health Planning; Healthcare; Healthcare Systems; Home environment; Hospitals; Individual; Inpatients; Interview; Knowledge; Lead; Medical; Mental Health; Mental disorders; Modeling; Outcome; Pharmaceutical Preparations; Population; Provider; Psychotic Disorders; Qualifying; Recovery; Relapse; Resources; Sampling; Schizophrenia; Schools; Services; Structure; Suicide attempt; System; Time; Treatment Efficacy; Vulnerable Populations; Work; base; clinical practice; cohort; community based service; evidence base; first episode psychosis; improved; improved outcome; innovation; interest; male; programs; trend; young adult

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.

项目概要 成年早期是精神分裂症最常见的发病时期。在首发精神病 (FEP) 期间及早识别和接受综合治疗可以改善康复、结果和复发率。然而，美国的研究一致发现，未经治疗的精神病的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美国支离破碎的医疗保健系统。年轻人通常没有多少资源和途径来获得公共项目的资格，这些项目可以帮助个人获得 SMI 患者可能可以获得的一系列复杂的医疗和其他服务。最近与 FEP 治疗相关的证据基础以及如何最好地提供这些治疗的改进有可能导致早期发现并改善这一弱势群体的结果。然而，尚不清楚证据基础上的这些变化是否已扩散到临床实践中。患有新出现的精神健康障碍的个人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持续时间、更合适的药物类型和剂量、由更合适的合格提供者进行的治疗、支持服务和针对一般医疗状况的治疗。在本研究中，通过检查不同年龄的年轻人的结果趋势，我们的目标是： 目标 1：检查年轻精神病患者的住院和急诊治疗是否以及如何随时间变化，并探讨任何变化的决定因素；目标 2：检查精神病住院治疗的再入院率是否以及如何随时间变化，并探讨任何变化的决定因素；目标 3：检查诊断为精神病的年轻人中因可能自杀企图而前往急诊室就诊的比率是否以及如何随时间变化，并探讨任何变化的决定因素。此外，我们的目标是： 目标 4（探索性）：描述针对 FEP 年轻人的公共计划福利的国家和计划创新。对于目标 1-3，我们将使用国家和州的入院和急诊科使用数据来比较不同州不同年龄和群体的结果趋势。对于目标 4，我们将与来自各州、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 和其他新兴 SMI 的弱势个体相关的创新。当人们在学校、进入职场、组建家庭或做出其他会影响一生的选择时，精神病就会发作。最近的科学研究工作为改善对这一弱势群体的护理提供了机会，可能会导致终生功能的增加。这项工作将与有兴趣更好地了解为患有新兴 SMI 的个人提供更全面和创新服务的好处的董事和其他利益相关者相关。