Melanie Barwick, Janet Durbin, George Foussias, Emily Panzarella, Marleine Saliba, Sandy Brooks, Elaine Stasiulis, Raluca Dubrowski, Paul Kurdyak, Sanjeev Sockalingam, Donald Addington, Augustina Ampofo, Kelly Anderson, Sarah Bromley, Monica Choi, Simone Dahrouge, Lillian Duda, Alexia Jaouich, Christopher Koegl, Carol Maxwell, Dielle Miranda, Claire de Oliveira, Alexia Polillo, Valerie Primeau, John Riley, Dayna Rossi, Eva Serhal, Jill Shakespeare, Sophie Soklaridis, Diana Urajnik, Nicole Kozloff, Aristotle Voineskos
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We hypothesized that facilitated implementation of NAVIGATE, an evidence-based, standardized model of coordinated specialty care, would increase fidelity to EPI standards and improve patient functioning in real-world settings.</p><p><strong>Study design: </strong>The Early Psychosis Intervention-Spreading Evidence-based Treatment (EPI-SET) study was a non-randomized effectiveness-implementation hybrid type III trial in 6 Ontario EPI programs. We used the First Episode Psychosis Services-Fidelity Scale-Revised (FEPS-FS-R) to measure fidelity to EPI standards at baseline (T0) and 12 months (T1). Scores ranged from 1 to 5, indicating poor (<3.5), fair (3.5-4), and good (≥4.0) adherence. The Heinrichs-Carpenter Quality of Life Scale (QLS) was used to determine change in functioning from baseline to 12 months (which roughly coincided with the T1 fidelity assessment). 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引用次数: 0
摘要
背景和假设：虽然早期精神病干预（EPI）服务是有效的，但护理提供往往不一致，特别是在以康复为导向的护理中。我们假设，促进导航的实施，一个基于证据的，标准化的协调专业护理模型，将增加对EPI标准的保真度，并改善患者在现实环境中的功能。研究设计：早期精神病干预-推广循证治疗（EPI- set）研究是一项在安大略省6个EPI项目中进行的非随机有效性-实施混合III型试验。我们使用首发精神病服务保真度量表修订版（FEPS-FS-R）来测量基线（T0）和12个月（T1）对EPI标准的保真度。研究结果：FEPS-FS-R评分显示T0时19/29项依从性良好，T1时17/29项依从性良好。与T0相比，在T1时，更多的社会心理治疗项目和更少的可及性和连续性项目达到了公平或更好的依从性。在完成基线评估的100名参与者中，从T0到T1， QLS总分显著提高（估计变化= 13.6,95% CI: 9.6-17.7, P < 0.001）。实现经验因站点而异，6个组织中有4个报告了总体的积极经验。结论：实施导航与提高护理的社会心理成分的保真度有关，并伴随患者功能的改善。这些发现可以为广泛实施NAVIGATE提供信息。
Fidelity, Implementation Determinants, and Patient-Level Outcomes Following Initial Implementation of NAVIGATE in the Early Psychosis Intervention-Spreading Evidence-Based Treatment (EPI-SET) Study.
Background and hypothesis: While early psychosis intervention (EPI) services are effective, care delivery is often inconsistent, particularly in recovery-oriented care. We hypothesized that facilitated implementation of NAVIGATE, an evidence-based, standardized model of coordinated specialty care, would increase fidelity to EPI standards and improve patient functioning in real-world settings.
Study design: The Early Psychosis Intervention-Spreading Evidence-based Treatment (EPI-SET) study was a non-randomized effectiveness-implementation hybrid type III trial in 6 Ontario EPI programs. We used the First Episode Psychosis Services-Fidelity Scale-Revised (FEPS-FS-R) to measure fidelity to EPI standards at baseline (T0) and 12 months (T1). Scores ranged from 1 to 5, indicating poor (<3.5), fair (3.5-4), and good (≥4.0) adherence. The Heinrichs-Carpenter Quality of Life Scale (QLS) was used to determine change in functioning from baseline to 12 months (which roughly coincided with the T1 fidelity assessment). Implementation determinants were assessed using the Consolidated Framework of Implementation Research.
Study results: FEPS-FS-R scores indicated good adherence for 19/29 items at T0 and 17/29 items at T1. Compared to T0, at T1, more psychosocial treatment items and fewer access and continuity items achieved fair or better adherence. Among the 100 participants who completed a baseline assessment, QLS total scores improved significantly (estimated change = 13.6, 95% CI: 9.6-17.7, P < .001) from T0 to T1. Implementation experiences varied across sites, with 4 of 6 organizations reporting overall positive experiences.
Conclusions: Implementation of NAVIGATE was associated with improved fidelity to psychosocial components of care, with concomitant improvements in patient functioning. These findings can inform widespread implementation of NAVIGATE.
期刊介绍：
Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.
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