This application proposes OnTrackNY as a regional scientific hub for the Early Psychosis Intervention Network (EPINET) program as part of NIMH's creation of a national learning health care system (LHS) for early psychosis care. OnTrackNY has grown into a 21-site network, under the leadership of Lisa Dixon, MD, MPH. Created and supported by the New York State's Office of Mental Health (OMH), OnTrackNY is a nationally recognized model providing coordinated specialty care (CSC) for adolescents and young adults within two years of the onset of non-affective psychosis. OMH regulates and licenses all mental health programs in New York and is a direct-services provider via state-operated programs statewide. This makes OMH an ideal partner for establishing a statewide learning health care system for early psychosis care. Further, OnTrackNY's administration, OnTrackCentral, operates within the OMH-supported Center for Practice Innovations at Columbia Psychiatry. This location within a vibrant academic research enterprise supports OMH's mission of scaling up CSC services statewide while addressing key practice-based research questions in the delivery of CSC care. In this model, OnTrackCentral serves as the hub and the 21 OnTrackNY programs serve as the spokes. Since 2014, the still-growing OnTrackNY network has served over 1,200 individuals. From its inception, OnTrackNY has aimed to deliver high-quality, data-driven, accountable and culturally competent care consistent with an LHS. As a condition of funding, all OnTrackNY providers follow established protocols that require submission of patient- and site-level standard measures of early psychosis clinical features, services, and treatment outcomes. Notwithstanding OnTrackNY's considerable strengths, it lacks key supports and resources needed to fully implement the Institute of Medicine's (IOM's) model for a continuously learning healthcare system that connects multiple stakeholders from across a healthcare system to capture and review data, identify new technologies and approaches, and develop and apply strategies to improve quality and increase efficiency. Our proposed EPINET regional hub, the OnTrackNY LHS, will emphasize and enhance two critical foundational components - Aim 1: proactively engage stakeholders to optimize understanding of key problems and their solutions at every LHS phase;
and Aim 2 : develop data systems with enhanced standardized data collection, including post-discharge data and linkages to external data systems, and enhancing data analytics that will allow for client-level treatment planning and prospective analytics, delivering real time, dynamic and actionable information to stakeholders. These LHS components do not follow in a step- wise sequence but instead operate in parallel and interact to facilitate and enhance quality improvement processes. This backbone will support the development of practice-based research (Aim 3); the initial project will address the knowledge gap in addressing suicidal ideation and behavior among people with early psychosis by developing and testing an adapted suicide prevention protocol.
This learning healthcare system will utilize an intensive and unprecedented multi-tier systemwide focus on stakeholder participation (including clients, families, clinicians, payors, administrators and government leaders). This participation will be infused with knowledge obtained from state-of-the-art data systems capabilities; together they will form the backbone to support innovative practice-based research. These processes will work together within the learning healthcare system to develop quality improvement activities that will enable the OnTrackNY program to provide feasible, acceptable, and high-quality services, and will facilitate coordination with national efforts to improve public health by innovating care for young people with early psychosis.
