Real-world implementation of precision psychiatry: Transdiagnostic risk calculator for the automatic detection of individuals at-risk of psychosis

Abstract

Background Risk estimation models integrated into Electronic Health Records (EHRs) can deliver innovative approaches in psychiatry, but clinicians' endorsement and their real-world usability are unknown. This study aimed to investigate the real-world feasibility of implementing an individualised, transdiagnostic risk calculator to automatically screen EHRs and detect individuals at-risk for psychosis. Methods Feasibility implementation study encompassing an in-vitro phase (March 2018 to May 2018) and in-vivo phase (May 2018 to April 2019). The in-vitro phase addressed implementation barriers and embedded the risk calculator (predictors: age, gender, ethnicity, index cluster diagnosis, age*gender) into the local EHR. The in-vivo phase investigated the real-world feasibility of screening individuals accessing secondary mental healthcare at the South London and Maudsley NHS Trust. The primary outcome was adherence of clinicians to automatic EHR screening, defined by the proportion of clinicians who responded to alerts from the risk calculator, over those contacted. Results In-vitro phase : implementation barriers were identified/overcome with clinician and service user engagement, and the calculator was successfully integrated into the local EHR through the CogStack platform. In-vivo phase : 3722 individuals were automatically screened and 115 were detected. Clinician adherence was 74% without outreach and 85% with outreach. One-third of clinicians responded to the first email (37.1%) or phone calls (33.7%). Among those detected, cumulative risk of developing psychosis was 12% at six-month follow-up. Conclusion This is the first implementation study suggesting that combining precision psychiatry and EHR methods to improve detection of individuals with emerging psychosis is feasible. Future psychiatric implementation research is urgently needed.

Implementing Precision Psychiatry: A Systematic Review of Individualized Prediction Models for Clinical Practice

“…The current systematic review identified only one implementation study, corresponding to 0.2% of the total pool of models developed and published, which did not report data but only described the research protocol of an ongoing project 120 (the full implementation results have been published upon completion of our literature review). 121 , 122 At the moment, precision psychiatry is severely limited by a translational gap. The implementation pathways of precision psychiatry is a perilous journey, 123 complicated by obstacles related to patients (eg, making their data available or accepting the outputs of the risk calculator), clinicians (eg, adherence to the recommendations made by prediction models and communicating risks), providers (eg, confidentiality and accessibility of data and interpretability and utility of outputs), and funders and organizations (implementing an infrastructure enabling standard prediction procedures).…”

Preventive psychiatry: a blueprint for improving the mental health of young people

“…In fact, a systematic review has found that only about 5% of the total pool of risk prediction models published in psychiatry is externally validated, and that only 0.2% are being considered for implementation (most models may not cross the implementation threshold, as they would not improve outcomes), highlighting a profound replication and translational gap 240 . For example, across all prognostic models reviewed in Table 5, only the transdiagnostic risk calculator has been piloted for real-world implementation in clinical practice 241 .…”

Sektorenübergreifende Therapiekonzepte und innovative Technologien: neue Möglichkeiten für die Versorgung von Patienten mit psychischen Erkrankungen

“…Die Autoren schlussfolgerten, dass ein individualisiertes prognostisches Modell, das die künstliche und menschliche Intelligenz integriert, die personalisierte Prävention psychotischer Störungen bei Menschen mit Psychoserisikosyndromen oder kürzlich aufgetretenen Depressionen erleichtern könnte. Inzwischen sind auch individualisierte Onlinerisikorechner für die transdiagnostische Vorhersage von Psychosen in der psychiatrischen Versorgung verfügbar [57][58][59][60].…”