Academic-Community EPINET (AC-EPINET): Mitigating Barriers to Care

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. Challenges
associated with CSC that, if addressed, would further enhance its effectiveness include the utilization of health
care data to continuously improve clinical decision-making and services delivery. In addition, innovative
interventions that strengthen treatment engagement and improve key outcomes, such as hospitalization rates,
would also enhance CSC effectiveness. The Academic-Community EPINET (AC-EPINET) 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 a Learning Healthcare System (LHS), embedded in the
everyday workflow of spoke clinics, to identify performance gaps, drive continuous quality improvement and
enable practice-based research. The LHS will utilize the EPINET common assessment battery and CSC-ONE
will serve as the informatics platform. It passively extracts data from electronic health records to minimize dual
entry and supports 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. 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 and experience with telehealth (TH). The central hub will provide
study governance, oversight, data management, training, data transfer to the NDCC. The leadership team has
deep expertise in comparative effectiveness trials, TH services delivery, informatics, and large data set
outcomes analytics. Thus, the AC-EPINET is well positioned to achieve data-driven, improved clinical services
through the use of a common assessment battery. Moreover, we will assess the effectiveness of CSC
treatment delivered through telehealth (CSC-TH) compared to standard, clinic-based CSC (CSC-SD) to
improve engagement and hospitalization rates in a 12-month, randomized trial. Several studies have
demonstrated that TH treatment enhances engagement by overcoming barriers, such as long travel commutes
to clinics, unavailability of reliable transportation for clinic appointments, stigma associated with receiving care
in psychiatric clinics, and inconveniences adapting to inflexible service schedules and workflow patterns. In
addition, TH treatment has shown advantages for decreasing hospitalization rates, which is supported by our
preliminary studies. Combined with the LHS, the TH intervention has the potential to enhance the effectiveness
of AC-EPINET to improve the lives and outcomes of individuals with early psychosis.

Grant Number: 5R01MH120588-04
NIH Institute/Center: NIH
Principal Investigator: Alan Breier