Early-Phase Psychosis: Practice-Based Research to Improve Treatment Outcomes - Project Summary/Abstract Our group has a long-standing commitment to improving care for individuals with first episode psychosis (FEP), e.g. we developed the NAVIGATE coordinated specialty care (CSC) treatment model for the RAISE-ETP study. The current EPINET project allowed us to improve FEP care within a learning health system (LHS) framework. Our current ESPRITO EPINET has enrolled 963 participants. Our proposed ESPRITO EPINET will enroll an additional 625 participants from 13 clinics in 6 states. All sites provide care with the NAVIGATE model, serve diverse populations and except for one are community facilities without any academic affiliations. Moving forward, the ESPRITO central team will continue to provide sites the successful supports developed in the current ESPRITO for LHS and research project recruitment, retention, obtaining core assessment battery (CAB) assessments, data management including provision of CAB data to the EPINET Data Coordinating Center. NAVIGATE treatment and the LHS model are based upon measurement-based care and we will continue on-going training to site personnel on assessment and the use of assessments to improve care. For the proposed work, we will expand the range of dashboards and means to convey information to sites. Our statistical analyses include innovations both in the methods that will be used and the incorporation of visualization tools to communicate the results to clinicians who may have limited statistical expertise. A novel measure will be used to evaluate social determinants of health (SDoH) to further understand site diversity. Combining data from the current ESPRITO project and the proposed work will also permit analyses of subpopulations of interest (e.g., those of Hispanic ethnicity). To enhance sites’ ability to improve care the proposed work includes a learning collaborative about overall treatment issues and another about enhancing patient participation in the LHS and in NAVIGATE treatment. We will also mentor the next generation of LHS/CSC research and clinical leaders. We will also perform 2 research studies. 1) Determine clinical characteristics of individuals who disengage from the LHS or from NAVIGATE treatment. Using data that can be obtained during clinical care (e.g. the Core Assessment Battery) we will characterize patient participants who disengage at two levels: those who enroll in the LHS but do not participate in the data collection needed for measurement-based care and those who prematurely terminate all CSC treatment. 2) Determine the utility at real world clinics of automated speech and language analysis to identify participants at risk for treatment disengagement or for relapse and hospitalization. Automated speech and language analysis has the potential to provide sites important information about patient status beyond what is obtained by usual clinical measures. In addition to the 2 defined projects, we will also collaborate with other EPINET hubs via the EPINET research consortium and development of collaborative research projects.
