Forging a learning health system for early psychosis: Insights from the academic community EPINET

Psychosis can lead to deleterious outcomes with multifaceted personal and societal costs, but the provision of intervention services early in the illness course positively influences disease trajectory. There has been a growing emphasis on innovation and expansion of first episode services (FES). Yet, such care has not universally delivered on the promise of meeting the needs of individuals with first-episode psychosis. The Academic Community Early Psychosis Intervention Network (AC-EPINET) is one of eight regional hubs envisioned by NIH to function as a learning healthcare system (LHS) to advance the quality of early intervention care. AC-EPINET spans three geographically distinct areas of the U.S. (Midwest: Indiana, Michigan, Ohio; Southeastern: Tennessee, Louisiana; and Northeastern: Connecticut, New York) with six academically oriented, community-facing FES' and an informatics site. Our goals were to strengthen existing services, expand them to collect common data elements within clinical workflows, leverage informatics, support practice-based research, and engage stakeholders to ultimately build a culture of continuous learning and quality improvement. We designed and implemented an infrastructure consisting of a centralized two-site administrative team supporting an inclusive steering committee, three work groups, and the six clinical sites. Common data capture at enrollment and consecutive six-month intervals was integrated into clinical workflows. An informatics workflow that included evidence-based benchmarked outcome visualization, for each site and across the entire network, was designed and deployed to enable shared learning and ongoing quality improvement efforts. Design and implementation lessons presented are relevant to LHS development and dissemination of FES quality improvement and research efforts.