Signature Project

招牌项目

基本信息

批准号：
10436046
负责人：
Cynthia Ann Fontanella
金额：
$ 75.63万
依托单位：
RESEARCH INST NATIONWIDE CHILDREN'S HOSP
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-01 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10436046
关键词：
Academy Accident and Emergency department Address Adolescent American Caring Cause of Death Cessation of life Childhood Clinical Clinical Pathways Clinical Trials Communities Community Practice Detection Effectiveness of Interventions Evidence based intervention Family Feeling suicidal Health Personnel Health Professional Healthy People 2020 Hybrids Individual Intervention Intervention Studies Interview Knowledge Low income Mediating Mediator of activation protein Mental Health Modeling Morbidity - disease rate National Institute of Mental Health Ohio Outcome Outcome Assessment Outcome Measure Pathway interactions Patient-Focused Outcomes Patients Pediatrics Phase Pilot Projects Prevention strategy Primary Health Care Process Protocols documentation Provider Public Health Randomized Controlled Trials Reporting Research Research Design Risk Risk Assessment Risk Management Safety Self Efficacy Service setting Site Strategic Planning Suicide Suicide attempt Suicide prevention Surveys Testing Time Time trend Triage Youth aged base clinical care design effectiveness evaluation effectiveness implementation study effectiveness research effectiveness testing evidence base follow-up high risk population implementation facilitators improved intervention effect non-suicidal self injury organizational readiness pediatrician population based practice setting preventive intervention primary care setting recruit reducing suicide routine care rural setting satisfaction screening secondary outcome suicidal behavior suicidal morbidity suicidal risk therapy design treatment as usual treatment effect urban setting

项目摘要

Suicide is the second leading cause of death in those aged 10 to 19 years; it is a critical public health problem. Suicidal ideation and nonfatal suicide attempts are even more prevalent and result in substantial morbidity and increased risk of suicide. Pediatric primary care is an ideal service setting for intervention research designed to rapidly reduce suicide and suicidal behaviors among US youth, as 80% of youth who die by suicide are seen by their primary care clinicians (PCC) in the year prior to death while only 20% have contact with a mental health professional. Despite the importance of identifying youth at risk for suicidal behavior, most PCCs do not routinely screen for suicide. In recent years, new treatment and management strategies have been developed, tested and implemented in some organizations, but they are not yet widely used. Existing clinical trials have tended to focus on testing effectiveness of evidenced-based interventions (e.g., universal screening, safety planning) for high-risk populations in emergency departments; less is known about the efficacy of these approaches in primary care settings. Research is critically needed to test the effectiveness of evidence-informed practices to reduce suicide risk for youth treated in primary care. To address this gap, we propose a stepped wedge hybrid effectiveness-implementation cluster-randomized controlled trial to test effectiveness of a population-based quality improvement (QI) intervention, Stepped Approach to Reducing Suicide in Primary Care (STARRS_PC) that implements a clinical pathway for youth identified by screening as being at elevated risk for suicide. The pathway is designed to promote the use of evidence-based suicide clinical care processes and includes three separate components: suicide risk screening, risk assessment and triage, and care management. The application builds on a pilot study of real- world implementation of suicide risk screening into a pediatric primary care setting, using an iterative Plan, Do, Study, Act (PDSA) quality improvement approach that was well-accepted by patients, families, and PCCs. In the proposed study, we will test the effectiveness of STARRS-PC relative to treatment as usual (TAU) on primary (suicidal attempts and suicide deaths), secondary outcomes (suicidal ideation, non-suicidal self-injury, and family satisfaction) at 3, 6, 12 months post-baseline; examine clinicians’ knowledge, self-efficacy, and buy- in regarding suicide risk screening, assessment, and management as mechanisms of change; and organizational factors (e.g., organizational readiness and practice integrations) as potential moderators of the treatment effect on patient outcomes During this five-year project, we will recruit and assess 2274 youth aged 12 to 17 years from 12 primary care sites, including 910 youths during the TAU phase and 1364 youths during the Screening + Intervention phase. Participating sites serve vulnerable low-income youth in urban and rural settings in central and southeastern Ohio.

自杀是10至19岁那年的第二大死亡原因。这是一个关键的公共卫生问题。自杀思想和非致命自杀企图更加普遍，并导致大量发病率和自杀的风险增加。小儿初级保健是用于干预研究的理想服务环境我们年轻人中迅速减少自杀和自杀行为，因为看到80％因自杀而死的年轻人在死亡前一年，其初级保健临床医生（PCC），而只有20％与精神联系卫生专业人员。尽管确定有自杀行为风险的年轻人的重要性，但大多数PCC并不定期筛选自杀。近年来，已经制定，测试和实施了新的治疗和管理策略在某些组织中，但尚未被广泛使用。现有的临床试验倾向于专注于测试高风险的基于经验的干预措施（例如，通用筛查，安全计划）的有效性急诊部门的人口；关于这些方法在初级保健中的效率知之甚少设置。需要进行研究以测试证据信息的实践的有效性以减少在初级保健中接受青年的自杀风险。为了解决这一差距，我们提出了一个阶梯式楔形混合有效性 - 实现群集随机化对照试验以测试基于人群质量改善（QI）干预的有效性，减少在实现青年临床途径的初级保健自杀（Starrs_pc）中自杀的方法通过筛查确定为自杀风险较高。该路径旨在促进使用循证自杀临床护理过程，包括三个独立的组成部分：自杀风险筛查，风险评估和分类以及护理管理。该申请是基于实施的试点研究使用迭代计划，世界实施自杀风险筛查到儿科初级保健环境中研究，ACT（PDSA）质量改进方法已被患者，家庭和PCC良好接受。在拟议的研究，我们将测试Starrs-PC相对于往常的治疗（TAU）的有效性（TAU）初级（自杀企图和自杀死亡），次要结果（自杀思想，非自杀自我伤害，和家庭满意度）在基线后3、6、12个月；检查临床医生的知识，自我有效和购买 - 关于自杀风险筛查，评估和管理作为变化机制；和组织因素（例如组织准备和实践融合）作为潜在的主持人在这个五年项目中，对患者预后的治疗效果，我们将招募和评估2274名年龄从12个初级保健站点开始12到17年筛选 +干预阶段。参与的网站为城市和农村地区的脆弱低收入青年服务俄亥俄州中部和东南部的设置。