Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
Research and Development, Southern Health NHS Foundation Trust, Southampton, UK.
BMJ Open. 2020 Apr 29;10(4):e033711. doi: 10.1136/bmjopen-2019-033711.
To evaluate whether a newly developed care pathway, Treatment and Recovery In PsycHosis (TRIumPH), is feasible, acceptable and effective in meeting National Institute of Health and Care Excellence (NICE) quality standards in a timely manner.
This is a pragmatic, non-randomised, prospective, mixed methods study comparing an implementation (TRIumPH) and comparator site (not implementing TRIumPH) across three cohorts to assess feasibility, acceptability and effectiveness of the integrated pathway.
Early intervention in psychosis (EIP) services at two National Health Service organisations in South of England.
All patients accepted into EIP services between 1 June 2014 and 31 May 2017 were each followed up for 1 year within their respective cohorts.
Quantitative data consisted of routinely collected clinical data retrieved from patient records to assess whether the implementation of TRIumPH achieved better concordance to NICE standards. These included time to access services, physical health assessments, clinical outcomes based timeliness of delivery and acute data. The controlled trial has evaluated the effect of TRIumPH (Intervention) with Care As Usual (Comparator). Qualitative measures consisted of questionnaires, interviews and focus groups to assess acceptability and satisfaction. Outcome measures were compared within the baseline, year 1 and year 2 cohorts and between the two sites. Quantitative data were statistically analysed by comparing means and proportions.
Time to assessment improved in the implementation site and remained within the target in comparator site. Meeting of quality standards increased substantially in the implementation site but was more variable and reached lower levels in the comparator site especially for physical health standards. Cognitive therapy for psychosis, family intervention and carer and employment support were all offered to a greater extent in the implementation site and uptake increased over the period.
Pathway implementation generally led to greater improvements in achievement of access and quality standards compared with comparator site.
UK Clinical Research Network Portfolio (19187).
评估新开发的治疗和康复精神病路径（TRIUMPH）是否能及时满足国家卫生与保健卓越研究所（NICE）的质量标准，具有可行性、可接受性和有效性。
这是一项实用的、非随机的、前瞻性的混合方法研究，比较了实施（TRIUMPH）和对照点（不实施 TRIUMP）在三个队列中的情况，以评估综合途径的可行性、可接受性和有效性。
在英格兰南部的两个国家卫生服务机构的早期精神病干预（EIP）服务中。
2014 年 6 月 1 日至 2017 年 5 月 31 日期间，所有被纳入 EIP 服务的患者，在各自的队列中，随访 1 年。
定量数据由从患者记录中检索的常规收集的临床数据组成，以评估 TRIUMPH 的实施是否能更好地符合 NICE 标准。这些数据包括服务的访问时间、身体健康评估、根据及时性交付的临床结果以及急性数据。对照试验评估了 TRIUMPH（干预）与常规护理（对照）的效果。定性措施包括问卷、访谈和焦点小组，以评估可接受性和满意度。在基线、第 1 年和第 2 年的队列中比较了结果测量值，并在两个地点之间进行了比较。定量数据通过比较平均值和比例进行了统计分析。
评估时间在实施点有所改善，在对照点仍在目标范围内。实施点的质量标准大幅提高，但在对照点更为多变，尤其是在身体健康标准方面，达到的水平较低。精神病认知疗法、家庭干预以及照顾者和就业支持在实施点都得到了更大程度的提供，并且在这段时间内使用率有所增加。
与对照点相比，途径的实施通常会导致在实现获取和质量标准方面有更大的改善。
英国临床研究网络投资组合（19187）。
