# Examining Pathways to Care

> **NIH NIH P50** · MCLEAN HOSPITAL · 2020 · $237,050

## Abstract

1. Abstract
Project 1 will examine the impact of increasing availability of coordinated specialty care (CSC) for patients in
their first episode of psychosis (FEP). The growing clinical evidence base supporting CSC, combined with
recent federal/state policy changes, has led to increased financing and availability of CSC care in the United
States. There is, however, limited information on the impact of these changes on patients or clinical care, and
limited data to guide future policy decisions. Moreover, these changes are occurring within a highly fragmented
and under-resourced delivery system for mental health care. For example, in many parts of the United States,
there are few or no psychiatrists in the area, much less mental health clinics that could implement CSC.
Recent federal increases in FEP financing help address these needs, but the funds are limited and future
investment decisions will need to be judicious. To address these gaps, we propose to use population level
information from multiple sources, starting with the Massachusetts All Payer Claims Database (APCD),
supplemented with state data on FEP clinics, and other area-level information. We will apply state-of-the-art
statistical approaches for making causal inferences about the growth in CSC availability and our study
outcomes. We have three study aims: 1) Differential access – we will compare the characteristics and history
of patients receiving care in clinics offering CSC versus elsewhere; 2) Outpatient care – estimation of the effect
of receiving care in a clinic offering CSC on outpatient process measures, e.g., time to follow-up care,
assessment of lipid status, and adherence to antipsychotic drug therapy; and 3) Unfavorable clinical events –
examination of the effects on emergency department visits or hospitalizations. Our approach addresses
several major gaps in the literature by including as much as ten years of follow-up after diagnosis, leveraging
data on tens of thousands of newly diagnosed patients (thereby having adequate power to estimate changes
precisely), and having near complete follow-up on all subjects (through the state APCD). This information will
supplement existing knowledge from prior clinical trials, support the other projects in this NIMH P50 LEAP
Center, and help frame the potential generalizability of information gained from advanced mental health clinics.
This information could help inform federal and state policy as well as decisions by patients, clinicians, and
organizational decision-makers.

## Key facts

- **NIH application ID:** 9928118
- **Project number:** 5P50MH115846-02
- **Recipient organization:** MCLEAN HOSPITAL
- **Principal Investigator:** JOHN HSU
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $237,050
- **Award type:** 5
- **Project period:** — → —

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9928118

## Citation

> US National Institutes of Health, RePORTER application 9928118, Examining Pathways to Care (5P50MH115846-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9928118. Licensed CC0.

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