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Promoting High-Value Mental Health Care
Published Online: 2 June 2022

Reducing Delay From Referral to Admission at a U.S. First-Episode Psychosis Service: A Quality Improvement Initiative

Maria Ferrara, M.D., Ph.D. [email protected], Keith Gallagher, M.D., Laura A. Yoviene Sykes, Ph.D., Philip Markovich, B.A., Fangyong Li, M.P.H., Jessica M. Pollard, Ph.D., Shannon Imetovski, M.P.H., John Cahill, M.D., Ph.D., Sinan Guloksuz, M.D., Ph.D., and Vinod H. Srihari, M.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 73, Number 12
https://doi.org/10.1176/appi.ps.202100374
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Abstract

Duration of untreated psychosis (DUP), the period between psychosis onset and entry into care, is a time of great vulnerability. Longer DUP predicts poorer outcomes, and delayed treatment access can limit the effectiveness of coordinated specialty care (CSC) services. This column details one component of a broader early detection campaign, a quality improvement intervention focusing on reducing the delay between confirmation of eligibility and admission to care within a benchmark period of 7 days. Median delay significantly fell (from 13.5 to 3 days), and the proportion of admissions that met the benchmark increased (from 33% to 71%) over 4 years. This intervention provides a sustainable model to reduce wait times at CSC services.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 73 • Number 12 • December 01, 2022
Pages: 1416 - 1419
PubMed: 35652190

History

Received: 22 June 2021
Revision received: 18 October 2021
Revision received: 24 January 2022
Revision received: 22 February 2022
Accepted: 17 March 2022
Published online: 2 June 2022
Published in print: December 01, 2022

Keywords

  1. Psychosis
  2. Quality improvement
  3. First episode psychosis
  4. Service delivery
  5. Public health
  6. Duration of untreated psychosis

Authors

Details

Maria Ferrara, M.D., Ph.D. [email protected]
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Keith Gallagher, M.D.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Laura A. Yoviene Sykes, Ph.D.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Philip Markovich, B.A.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Fangyong Li, M.P.H.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Jessica M. Pollard, Ph.D.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Shannon Imetovski, M.P.H.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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John Cahill, M.D., Ph.D.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Sinan Guloksuz, M.D., Ph.D.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Vinod H. Srihari, M.D.
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Ferrara, Gallagher, Yoviene Sykes, Markovich, Pollard, Imetovski, Cahill, Guloksuz, Srihari); Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy (Ferrara); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut (Li); Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands (Guloksuz).
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Notes

Send correspondence to Dr. Ferrara ([email protected]). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

This work was supported by the National Institutes of Health (R01 MH-103831 to Dr. Srihari), the Gustavus and Louise Pfeiffer Research Foundation, and the State of Connecticut, Department of Mental Health and Addiction Services. The study was registered on February 20, 2014, at ClinicalTrials.gov: NCT02069925.The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This column does not express the views of the Department of Mental Health and Addiction Services or of the State of Connecticut. The views and opinions expressed are those of the authors.

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