Academic-Community EPINET - Enhancing outcomes through improved stress tolerance in early psychosis

About This Grant

Overall 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. However, CSC programs face challenges to utilize health care data to continually improve clinical decision-making and services delivery, and to develop innovative interventions that improve key outcomes. The Academic- Community EPINET (AC-EPINET): Enhancing outcomes through improved stress tolerance in early psychosis 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 and embed a Learning Healthcare System (LHS) in the everyday workflow of spoke clinics to identify performance gaps, drive continuous quality improvement and enable practice-based research. In Aim 1, the LHS will utilize the EPINET common assessment battery (CAB), and CSC-HONE will serve as the informatics platform. It consolidates data from electronic health records, minimizing dual entry and supporting 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. In Aim 2, we will improve our LHS by expanding stakeholder involvement, integrating community partners with lived experience in the formation of a quality improvement incubator to improve care outcomes. 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 in and experience with real world research. The Administrative Core will provide study governance, oversight, data management, training, adherence to timelines and milestones, and secure, de-identified data transfer to the NDCC. The leadership team has deep expertise in stress research, behavioral treatments, clinical trials and large data set outcomes analytics. Thus, the AC-EPINET is well positioned to achieve data-driven, improved clinical services through the use of the CAB. For Aim 3, we will conduct two research projects focused on increased stress sensitivity in early psychosis and treatment to improve stress tolerance. Using data from the CAB, the Clinical Practice Data Research Project will develop an analytic model of how stress sensitivity affects functional outcomes. The Prospective Practice-Oriented Research Project will examine the preliminary effectiveness of mindfulness-based stress reduction treatment on stress sensitivity in EP. This research will inform the identification of at-risk participants with high stress sensitivity and related functional deficits who may be good candidates for targeted interventions.