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Early Psychosis Intervention Network (EPINET): A Learning Healthcare System for Early Serious Mental Illness

NAMHC Concept Clearance

Presenter

Robert K. Heinssen, Ph.D., ABPP
Division of Services and Intervention Research

Goal

This initiative aims to create a national Early Psychosis Intervention Network (EPINET) among treatment centers that offer evidence-based specialty care to persons experiencing subthreshold psychotic symptoms or a first episode of psychosis. EPINET will link clinical sites through common data elements, data sharing agreements, and a unified informatics approach for aggregating and analyzing pooled data. Systematic analyses of participant-level data collected in EPINET will help inform methods for achieving quality, safety, and value in early psychosis care and will accelerate research into psychosis risk factors, biomarkers of psychosis risk and onset, and pre-emptive interventions.

Rationale

NIMH has long supported empirical research into the earliest stages of psychotic illness, pursuing the goals of better diagnostic methods, more effective interventions, and improved outcomes for youth and young adults at risk for serious mental illness (SMI). Results from the Recovery After an Initial Schizophrenia Episode (RAISE) project and related studies highlight the value of early intervention for reducing the duration of untreated illness, speeding patients’ and family members’ access to appropriate care, and restoring normal school and work trajectories among individuals who receive evidence-based treatment.

A recent report from the Institute of Medicine1 describes the characteristics of a learning healthcare system as one that provides effective, high-quality care to all patients, and one which is constantly improving and innovating. In this framework, data routinely collected in clinical practice drive the process of scientific discovery, which itself becomes a natural outgrowth of patient care.2 NIMH estimates that approximately 60 clinics in the United States currently offer evidence-based early detection, indicated prevention, and treatment services to individuals in the earliest stages of psychotic illness. By 2017, this number will increase to over 100 clinics, as a result of new federal funding for early SMI treatment programs.3,4 The expansion of early intervention clinics across the States offers an unprecedented opportunity to develop a 21st century platform for delivering, studying, and refining evidence-based care for those at greatest risk for early SMI.

This initiative aims to:

  1. Select common data elements to characterize clinical high-risk (CHR) and first episode psychosis patients (FEP), assess treatment fidelity and quality, and measure key outcomes in a standardized manner.
  2. Adapt promising informatics platforms for collecting, aggregating, and manipulating clinical encounter data collected from up to 20 academic and community-based early psychosis treatment programs.
  3. Establish a data coordination center, with appropriate security processes and privacy procedures, to store and analyze data from 500-1000 CHR/FEP patients enrolled in early psychosis treatment programs.
  4. Evaluate relationships among clinical features, biological measures, treatment characteristics, and symptomatic and functional outcomes to accelerate understanding of biomarkers of psychosis risk and onset, as well as factors associated with recovery and cure.

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References

1 IOM (Institute of Medicine). 2013. Best care at lower cost: The path to continuously learning health care in America. Washington, DC: The National Academies Press.

2 Abernethy AP, Etheredge LM, Ganz PA, et al. 2010. Rapid-learning system for cancer care. Journal of Clinical Oncology, 28:4268-4274.

3 Consolidated Appropriations Act, 2014  

4 Consolidated and Further Continuing Appropriations Act, 2015