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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要如果自杀高危患者接受心理健康治疗，他们死于自杀的可能性就会降低。个人很难开始和持续参与心理健康服务，但没有研究表明不断制定和测试策略以增加自杀患者的治疗起始时间。根据 NIMH 的战略目标 4，加强 NIMH 支持的研究对公共卫生的影响，本研究的主要目标是制定可接受的、可行的、低成本且有效的策略，以增加在初级保健中确定自杀风险后，患者参加首次心理健康就诊。与一个大型、多元化的卫生系统合作，该系统已在八个城市初级保健中实施协作护理快速原型设计和测试有希望的策略以实现这一目标的实践。一系列严格的实验，以优化医疗保健以外的早期研究阶段的操作。通常使用这种方法来快速学习并在大规模决策之前在短时间内“降低风险”决策我们开发和测试的策略将基于行为经济学和实施科学。方法，利用宾夕法尼亚大学的 P50 ALACRITY 中心，并将包括以下策略：针对阻碍就诊的关键机制首先，我们将确定患者的特征。使用医疗记录和索赔数据进行转诊后是否参加首次心理健康检查。将应用既定方法进行情境调查，以确定心理健康的障碍和促进因素我们将采用直接观察和简短访谈的方式对有自杀风险的个人进行治疗。主要利益相关者（来自宾夕法尼亚州卫生系统内部和外部）了解主要障碍和促进因素最后，我们将快速建立原型并进行测试。使用实施科学和行为的既定程序来优化参与。经济学、相关理论和框架以及现有文献，我们将确定初步策略还将与团队合作制定支持首次心理健康访问的参与。自杀实施、科学、行为经济学以及初级和心理保健方面的专家。根据文献和我们之前的工作，我们预计可以增加动机的策略（例如，财务激励措施）和培养联系（例如，关爱联系人），然后我们将反复测试和确定。在整个过程中，我们期望完善这些初步策略，并发现更多障碍。促进者将使我们能够进一步完善和优化实施策略。支持启动心理健康的最有希望和最可行的实施战略清单这项工作的长期目标是为有自杀风险的患者提供服务，这将在后续试验中进行测试。增加对自杀者的心理健康服务的参与。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

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