Leveraging behavioral economics and implementation science to engage suicidal patients in mental health treatment

利用行为经济学和实施科学让自杀患者接受心理健康治疗

• 批准号: 10448434
• 负责人: Shari Jager-Hyman
• 金额: $ 24.38万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10448434
• 关键词: Address; Adult; Behavior; Behavioral; Caring; Case Management; Cessation of life; Characteristics; Collaborations; Data; Decision Making; Development; Evidence based practice; Feeling suicidal; Fostering; Funding; Glean; Goals; Health Personnel; Health system; Healthcare; Incentives; Individual; Industry; Insurance; Intake; Intervention; Interview; Learning; Literature; Measures; Medical Records; Medicare/Medicaid; Medicine; Mental Health; Mental Health Services; Methods; Motivation; National Institute of Mental Health; Outpatients; Output; Partner in relationship; Patient Self-Report; Patients; Pennsylvania; Persons; Primary Health Care; Procedures; Process; Public Health; Reporting; Request for Applications; Research Activity; Research Support; Risk; Sampling; Science; Series; Social support; Suicide; Suicide prevention; Testing; TimeLine; Universities; Visit; Work; base; behavior change; behavioral economics; behavioral health; care providers; collaborative care; cost; discounting; experience; experimental study; financial incentive; health service use; high risk; implementation evaluation; implementation science; implementation strategy; improved; insight; insurance claims; medical specialties; operation; prototype; screening; suicidal individual; suicidal morbidity; suicidal patient; suicidal risk; suicide rate; theories

PROJECT SUMMARY Patients at high risk for suicide are less likely to die by suicide if they engage in mental health treatment. Suicidal individuals have difficulty initiating and sustaining involvement in mental health services, yet no studies have systematically developed and tested strategies to increase treatment initiation for suicidal patients. Consistent with NIMH’s Strategic Objective 4 to strengthen the public health impact of NIMH-supported research, the primary objective of this study is to develop acceptable, feasible, low-cost, and effective strategies that increase patients’ attendance at a first mental health visit following identification of suicide risk in primary care. We will partner with a large, diverse health system that has implemented collaborative care in eight urban primary care practices to rapidly prototype and test promising strategies to achieve this objective. Rapid prototyping involves a series of rigorous experiments to optimize operations in the early-study stages. Industries outside of healthcare commonly use this approach to learn quickly and “de-risk” decision-making on a short timeline prior to a large rollout. The strategies we develop and test will be informed by behavioral economics and implementation science methods, leveraging the University of Pennsylvania’s P50 ALACRITY center, and will include strategies that target key mechanisms that impede treatment attendance. First, we will identify characteristics of patients who do or do not attend a first mental health visit following referral using medical records and claims data. Then, we will apply established approaches to contextual inquiry to identify barriers and facilitators to mental health treatment attendance for individuals at risk of suicide. We will use direct observation and brief interviews with key stakeholders (from within and outside of the Penn health system) to understand key barriers and facilitators to engaging patients at risk for suicide in mental health services. Finally, we will rapidly prototype and test strategies to optimize engagement. Using established procedures from implementation science and behavioral economics, relevant theories and frameworks and the extant literature, we will identify preliminary strategies to support attendance at first mental health visit. Strategies will also be developed in collaboration with a team of experts in suicide, implementation science, behavioral economics, and primary and mental health care. Based on the literature and our previous work, we anticipate that strategies that increase motivation (e.g., financial incentives) and foster connectedness (e.g., Caring Contacts) will be needed. We will then iteratively test and refine these preliminary strategies. Throughout this process, we expect to uncover additional barriers and facilitators that will allow us to further refine and optimize implementation strategies. The primary output will be a menu of the most promising and feasible implementation strategies to support the initiation of mental health services for patients at risk of suicide that will be tested in a subsequent trial. The long-term goal of this work is to increase engagement in mental health services for suicidal individuals.

项目摘要 如果患者进行心理健康治疗，则有自杀的高风险因自杀而少。自杀 个人难以发起和维持参与精神卫生服务，但没有研究 系统开发和测试的策略，以增加自杀患者的治疗计划。持续的 通过NIMH的战略目标4，增强了NIMH支持研究的公共卫生影响， 这项研究的主要目的是发展可接受，可行，低成本和有效的策略以增加 在鉴定初级保健自杀风险后，患者参加了第一次心理健康就诊。我们将 与一个大型潜水卫生系统合作，该系统已在八个城市初级保健中实施了协作护理 迅速原型和测试有希望的策略以实现这一目标的实践。快速原型涉及 一系列严格的实验，以优化早期研究阶段的操作。医疗保健以外的行业 通常使用这种方法来快速学习，并在大型时间表上在短时间内进行“风险”决策 推出。我们制定和测试的策略将由行为经济学和实施科学告知 方法，利用宾夕法尼亚大学的P50 Alacrity中心，并将包括 阻碍治疗出勤率的目标关键机制。首先，我们将确定患者的特征 使用医疗记录和索赔数据推荐后，请或不参加第一次心理健康访问。然后，我们 将采用既定方法来进行上下文查询，以确定心理健康的障碍和促进者 有自杀风险的个人的治疗出勤。我们将使用直接观察和简短的访谈 主要利益相关者（从宾夕法尼亚州卫生系统内外）了解关键障碍和促进者 吸引有自杀风险的患者在心理健康服务中。最后，我们将迅速原型和测试 优化参与的策略。使用实施科学和行为的既定程序 经济学，相关理论和框架以及文献的程度，我们将确定初步策略 首次心理健康访问时支持参加。策略还将与一个团队合作制定 自杀，实施科学，行为经济学以及初级和心理保健专家。基于 关于文献和以前的工作，我们预计会增加动力的策略（例如，财务 激励措施和寄养连接性（例如，关怀联系人）。然后，我们将进行迭代测试，并 完善这些初步策略。通过此过程，我们希望发现其他障碍， 促进者将使我们能够进一步完善并优化实施策略。主要输出将是 最有前途且可行的实施策略的菜单，以支持心理健康计划 在随后的试验中为有自杀风险的患者提供服务。这项工作的长期目标是 增加对自杀人士的心理健康服务的参与。

项目成果

Treating individuals with suicidal ideation in primary care: Patient-level characteristics associated with follow-up in the Collaborative Care Model.

在初级保健中治疗有自杀意念的个体：与协作护理模式中的随访相关的患者水平特征。

• DOI: 10.1111/sltb.13012
• 发表时间: 2024
• 期刊: Suicide & life-threatening behavior
• 影响因子: 3.2
• 作者: Candon,Molly;Wolk,CourtneyBenjamin;KattanKhazanov,Gabriela;Oslin,DavidW;Pieri,MatteoF;Press,MatthewJ;Anderson,Eleanor;Jager-Hyman,Shari
• 通讯作者: Jager-Hyman,Shari