Rapid Referral to Suicide Specific Intervention in Psychiatric Emergency Care

精神科紧急护理中快速转诊针对自杀的干预措施

• 批准号: 10216349
• 负责人: Colin A. Depp
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10216349
• 关键词: Accident and Emergency department; Acute; Address; Ambulatory Care; Appointment; Area; Behavior; Caring; Clinic; Clinical Trials; Computerized Medical Record; Data; Day Care; Diagnosis; Emergency Care; Evaluation; Evidence based intervention; Evidence based treatment; Feeling suicidal; Frequencies; Health Services Accessibility; Health Services Research; Healthcare; Hospitalization; Hybrids; Information Technology; Inpatients; Intervention; Joints; Management Information Systems; Measurement; Measures; Mediating; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Outcome; Outcome Measure; Outpatients; Persons; Prevention strategy; Provider; Psychotherapy; Randomized; Randomized Clinical Trials; Reporting; Research; Research Design; Research Methodology; Risk; Risk Factors; Risk Reduction; Schedule; Services; Severities; Site; Suicide; Suicide attempt; Suicide prevention; Tablets; Telephone; Time; Veterans; Walking; base; behavioral health; care coordination; evidence base; experience; follow-up; health information technology; high risk; hybrid type 1 design; improved; innovation; military veteran; novel; outreach; primary outcome; psychiatric emergency; recruit; secondary outcome; service coordination; stakeholder perspectives; suicidal behavior; suicidal risk; suicide rate; treatment as usual; urgent care

This revised proposal responds to HSR&D's Targeted Solicitation for Health Services Research on Suicide Prevention. Same-day psychiatric emergency clinics are increasingly implemented and are a best practice in increasing access to mental health care and in suicide prevention. Our preliminary data indicate a high frequency of suicidal ideation and recent suicidal behavior among Veterans accessing same-day mental health evaluation, and yet fewer than half of Veterans with these risk factors engage in outpatient mental health appointments that are set following their initial acute evaluation. To reduce risk of suicide during the transition from acute to outpatient care, it is unclear if models that “bridge” the transition should emphasize telephone outreach, as delivered by Suicide Prevention Coordination teams, or suicide-specific psychotherapy, such as Collaborative Assessment and Management of Suicidality (CAMS). CAMS is a brief transdiagnostic evidence-based psychotherapy that is recognized by the Joint Commission and Zero Suicide Framework as indicated for Veterans experiencing active suicidal ideation and/or recent suicidal behavior. This single-site 4- year randomized clinical trial addresses pragmatic questions regarding the relative impact of rapid referral to CAMS versus compared to outreach delivered by Suicide Prevention Coordinators for Veterans who are accessing same day mental health evaluation and who are gauged to be at elevated risk for suicide. In a Hybrid Type 1 research design, we propose to recruit Veterans from the same-day clinic setting who report recent or current active suicidal ideation and/or suicide attempt within the past 3 months. Veterans will be randomized to timely initiation of CAMS or to telephone outreach from Suicide Prevention Coordinators. The primary outcome (Aim 1) is the 12-month rate of suicide-related behavior or psychiatric hospitalization. Aim 2 contrasts indicators of operational efficiency between randomized conditions, including Veterans' rate of missed appointments at referred ongoing mental health care and urgent care re-presentation. We will also evaluate secondary outcomes (e.g., suicidal ideation severity). Aim 3 will examine the mediating impact of outpatient mental health treatment engagement on primary outcomes. Aim 4 evaluates fidelity to CAMS and its association with outcomes. Fidelity and in-person outcomes are measured by use of information technology, called eScreening, that is integrated with the electronic medical record and is used coordinate rapid referral and measurement-based care. This project builds on our preliminary data which indicate that research recruitment and rapid referral to CAMS therapy in same-day setting is highly feasible, acceptable and potentially impactful. This project is innovative in its focus on transitional care interventions in the same day clinic setting and its integration of health information technology to facilitate rapid referral, extensible to the dissemination of other evidence-based treatments. This research directly responds to the National Prioritized Research Agenda for Suicide Prevention, which emphasizes a need for care models that deliver “suicide-specific intervention as soon as risk is identified” and addresses important gaps on the impact of timely suicide prevention strategies identified the White House report. The study also responds to the HSR&D Mental and Behavioral Health, Access, and Care Coordination Priority Areas. We expect that these data will inform best practices in suicide prevention in same day mental health services where many at-risk Veterans are seen.

这项修订的提案回应了对自杀的卫生服务研究的针对性征集 预防。当天的精神病学紧急诊所越来越多地实施，是最佳实践 增加获得心理保健和预防自杀的机会。我们的初步数据表明很高 自杀念头的频率和近期的退伍军人自杀行为的频率 评估，但不到一半的退伍军人与这些危险因素有关门诊的心理健康 在初步急性评估之后设定的约会。降低自杀的风险 从急性到门诊护理的过渡，尚不清楚“桥接”过渡的模型是否应强调 通过自杀预防协调团队或自杀特异性心理治疗所提供的电话外展 例如自杀（CAMS）的协作评估和管理。凸轮是短暂的转诊 联合委员会和零自杀框架认可的循证心理治疗是 指示具有主动自杀想法和/或最近自杀行为的退伍军人。这个单站点4- 年度随机临床试验涉及有关快速推荐到的相对影响的务实问题 与自杀预防协调员提供的外展相比 获得同一天的心理健康评估，并估计谁处于自杀的风险较高。在杂种中 1型研究设计，我们建议从当日诊所环境中招募退伍军人，他们报告了最近或 过去三个月内，当前的主动自杀想法和/或自杀企图。退伍军人将是随机的 及时启动凸轮或从预防自杀协调员那里进行电话推广。主要 结果（AIM 1）是自杀相关行为或精神​​病住院的12个月率。目标2 对比是随机条件之间的操作效率的指标，包括退伍军人的比率 在正在进行的心理保健和紧急护理重新陈述的转诊中错过的任命。我们也会 评估次要结果（例如自杀的想法严重程度）。 AIM 3将检查中介的影响 对初级结果的门诊心理健康治疗参与。目标4评估对凸轮的保真度 它与结果的关联。通过使用信息来衡量保真度和面对面的结果 技术称为Escreing，与电子病历整合并使用坐标快速 转介和基于测量的护理。该项目以我们的初步数据为基础，这表明研究 在同一天环境中招募和快速转介到CAMS治疗是高度可行的，可接受的，并且 潜在影响力。该项目的专注于同一天的过渡护理干预措施 诊所环境及其整合健康信息技术以促进快速推荐，可扩展到 传播其他基于证据的治疗。这项研究直接回应了国家优先级 预防自杀的研究议程，该议程强调了需要提供“自杀特异性的护理模型 一旦确定风险，请尽快解决及时自杀影响的重要差距 预防策略确定了白宫报告。这项研究还对HSR＆d的心理做出了反应 行为健康，访问和护理协调优先领域。我们希望这些数据将最能告知 在同一天，可以看到许多高危退伍军人的精神卫生服务中的自杀习惯。