The Academic Community Early Psychosis Intervention Network: Toward building a novel learning health system across six US states

Abstract

Introduction: Compared to usual care, specialty services for first-episode psychosis (FES) have superior patient outcomes. The Early Psychosis Intervention Network (EPINET), comprised of eight U.S. regional clinical networks, aims to advance the quality of FES care within the ethos of learning healthcare systems (LHS). Among these, the Academic Community (AC) EPINET was established to provide FES care, collect common data elements, leverage informatics, foster a culture of continuous learning and quality improvement, and engage in practice-based research. Methods: We designed and implemented a novel LHS of university-affiliated FES programs within a hub (academic leadership team) and spoke (FES clinics) model. A series of site implementation meetings engaged stakeholders, setting the stage for a culture that values data collection and shared learning. We built clinical workflows to collect common data elements at enrollment and at consecutive 6-month intervals in parallel to an informatics workflow to deliver outcome visualizations and drive quality improvement efforts. Results: All six clinical sites successfully implemented data capture workflows and engaged in the process of designing the informatics platform. Upon developing the structure, processes, and initial culture of the LHS, a total of 614 patients enrolled in AC-EPINET, with the most common primary diagnoses of schizophrenia (32.1%) and unspecified psychotic disorders (23.6%). Visualized outcomes were delivered to clinical teams who began to consider locally relevant quality improvement projects. Conclusions: AC-EPINET is a novel LHS, with a simultaneous focus on science, informatics, incentives, and culture. The work of developing AC-EPINET thus far has highlighted the need for future LHS' to be mindful of the complexities of data security issues, develop more automated informatic workflows, resource quality assurance efforts, and attend to building the cultural infrastructure with the input of all stakeholders.