Signature Project

招牌项目

基本信息

批准号：
10487445
负责人：
GREGORY K BROWN
金额：
$ 112.21万
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：
2021-09-15 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10487445
关键词：
Accident and Emergency department Adoption Ambulatory Care Caring Clinical Communities Consultations Counseling Credentialing Data Educational Intervention Effectiveness Emergency Care Emergency Department patient Emergency department visit Evaluation Evidence based intervention Evidence based practice Frequencies Future Health Care Costs Health Services Health system Hospitalization Individual Intervention Mediating Mediation Medicine Mental Health Mental Health Services Methodology Minority Groups Modeling Monitor Nature Outpatients Patient Care Patient Monitoring Patient-Focused Outcomes Patients Phase Prevention strategy Primary Health Care Randomized Research Research Design Research Personnel Resources Risk Safety Self Efficacy Services Site Suicide Suicide attempt Suicide prevention Telephone Time Training United States Department of Veterans Affairs Veterans Visit acute care base behavioral health collaborative care comparative effectiveness study compare effectiveness cost cost effective design disadvantaged population effectiveness evaluation evidence base follow-up health care settings high risk implementation evaluation implementation outcomes implementation research implementation science implementation trial improved innovation insight intervention delivery novel novel strategies outpatient programs preventive intervention provider factors reducing suicide research study satisfaction suicidal suicidal behavior suicidal patient suicidal risk telehealth treatment as usual

项目摘要

The Signature Project of the Penn Innovation in Suicide Prevention Implementation Research (INSPIRE) Center is a large-scale research study designed to examine the effectiveness and implementation of an evidence-based intervention to lower suicide risk in health care settings. The Project will leverage the methodological and administrative support of the INSPIRE Center with its focus on optimizing implementation of practice-based suicide prevention interventions for minority and disadvantaged populations. Individuals at high risk for suicide often present to acute care settings, such as emergency departments (EDs), and then typically are hospitalized or referred for outpatient mental health treatment. Yet, despite being at increased risk of suicidal behavior and suicide following an ED visit, many patients do not attend outpatient treatment. Brief evidenced-based interventions such as the Safety Planning Intervention and follow-up services (SPI+) are available to mitigate this risk and engage patients in outpatient treatment. However, such practices often can be challenging for busy ED clinicians to provide for suicidal patients. Our interdisciplinary team of suicide, implementation, health services, qualitative and quantitative researchers as well as diverse stakeholder groups of ED clinicians, health systems leaders, mental health clinicians, and patients will collaborate to improve the delivery of ED-based suicide prevention efforts. We propose a novel delivery model in which ED staff will connect patients at risk for suicide to mental health clinicians who are located external to the ED. These off-site licensed and credentialed clinicians will provide SPI+ via telehealth for ED patients prior to discharge and provide follow-up services after ED discharge as part of an innovative Suicide Prevention Consultation Center (SPCC). The Project has three Specific Aims. Aim 1 will use a stepped-wedge cluster-randomized design to evaluate the effectiveness of SPI+ delivered by SPCC clinicians via telehealth compared to SPI+ delivered by SPI+-trained ED clinicians on rates of suicidal behavior and engagement in care following ED discharge. Aim 2 will evaluate the implementation of SPI+ delivered by SPCC clinicians compared to SPI+ delivered by ED clinicians on key implementation outcomes including adoption, fidelity, acceptability, and feasibility and will also explore the mediation of clinician intentions, norms, and self-efficacy on the fidelity of SPI+. Aim 3 will evaluate the costs to ED and SPCC practices and examine potential cost offsets to the health system to provide evidence of SPCC scalability and sustainability. If successful and cost effective, use of a SPCC, external to EDs, could become a scalable model for providing suicide prevention evidenced-based practices to those at risk for suicide presenting for emergency care with the potential to save lives.

宾夕法尼亚大学自杀预防创新实施研究（INSPIRE）中心的标志性项目是一项大规模研究，旨在检验基于证据的有效性和实施情况降低医疗机构自杀风险的干预措施。该项目将利用方法论和 INSPIRE 中心的行政支持，重点是优化基于实践的实施针对少数群体和弱势群体的自杀预防干预措施。自杀高危人群经常出现在急诊室 (ED) 等急症护理机构，然后通常会住院或转介接受门诊心理健康治疗。然而，尽管自杀行为的风险增加并且由于急诊科就诊后自杀，许多患者没有去门诊治疗。简短的基于证据的安全规划干预和后续服务 (SPI+) 等干预措施可用于缓解并让患者接受门诊治疗。然而，对于忙碌的人来说，这种做法往往具有挑战性急诊科临床医生为有自杀倾向的患者提供帮助。我们的自杀、实施、健康跨学科团队服务、定性和定量研究人员以及 ED 临床医生、健康等不同利益相关者群体系统领导者、心理健康临床医生和患者将合作改善基于急诊科的服务自杀预防工作。我们提出了一种新颖的交付模式，其中急诊室工作人员将连接有风险的患者急诊科以外的心理健康临床医生自杀。这些场外许可和认证临床医生将在出院前通过远程医疗为 ED 患者提供 SPI+，并在出院后提供后续服务作为创新型自杀预防咨询中心 (SPCC) 的一部分，急诊室出院。该项目共有三具体目标。目标 1 将使用阶梯楔形聚类随机设计来评估 SPI+ 的有效性由 SPCC 临床医生通过远程医疗提供的费用与由 SPI+ 培训的 ED 临床医生提供的 SPI+ 费用进行比较急诊科出院后的自杀行为和护理参与情况。目标 2 将评估实施情况 SPCC 临床医生提供的 SPI+ 与 ED 临床医生提供的 SPI+ 在关键实施方面的比较结果包括采用、忠诚度、可接受性和可行性，还将探索临床医生的调解意图、规范和自我效能感对 SPI+ 忠诚度的影响。目标 3 将评估 ED 和 SPCC 实践的成本并检查卫生系统的潜在成本抵消，以提供 SPCC 可扩展性和可持续性。如果成功且具有成本效益，在 ED 外部使用 SPCC 可能会成为一种可扩展的模型为那些因紧急情况而有自杀风险的人提供预防自杀的循证实践护理具有拯救生命的潜力。