Evaluating Effectiveness and Implementation of a Risk Model for Suicide Prevention Across Health Systems

评估跨卫生系统自杀预防风险模型的有效性和实施

基本信息

批准号：
10509346
负责人：
BobbiJo H. Yarborough
金额：
$ 81.66万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
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：
2022-08-23 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10509346
关键词：
Address Adopted Adult Bioinformatics Caring Clinic Clinical Clinical Data Collaborations Computer Models Data Effectiveness Electronic Health Record Elements Emergency Situation Ensure Failure Feedback Funding Health Care Visit Health Insurance Health Services Health system Healthcare Hybrids Individual Inpatients Intervention Leadership Measures Medicaid Medicare Mental Health Michigan Minnesota Modeling Monitor Movement National Institute of Mental Health Oregon Outcome Outpatients Patient Self-Report Patients Pilot Projects Population Heterogeneity Prevention approach Process Process Assessment Public Health Questionnaires Randomized Reach Effectiveness Adoption Implementation and Maintenance Research Resolution Risk Services Severities Site Suicide Suicide attempt Suicide prevention System Testing Time United States Washington advanced system base behavioral health clinical application clinical implementation cost data infrastructure design effectiveness evaluation effectiveness implementation trial effectiveness measure effectiveness outcome health care settings health record implementation design implementation evaluation implementation outcomes implementation questions improved innovation instrument insurance claims interest medical specialties member patient population pragmatic implementation pragmatic trial preference prevent prevention service reducing suicide response risk prediction screening service engagement statistics suicidal risk suicide model time use tool treatment as usual trial design

项目摘要

PROJECT SUMMARY/ABSTRACT: Suicide is a major public health concern in the United States; nearly 50,000 individuals die by suicide annually and almost 1.5 million attempt suicide. To date, identification of individuals at risk for suicide has relied on suicide risk screening practices, including using a variety of self- report instruments. However, sensitivity of these measures are only moderate; more precise tools for identifying patients at risk for suicide are needed. Suicide risk models, developed by our team, incorporate health records data and historical self-report screening questionnaire responses to improve accuracy of risk prediction. Our models have outperformed traditional clinical screening and similar risk models for adults receiving care in outpatient mental health specialty settings. However, while accurate, they have not been evaluated in real world care; whether the models actually increase identification or result in patients receiving more suicide prevention services, fewer crisis services, or making fewer suicide attempts is unknown. There is substantial clinical interest in implementing suicide risk models but little scientific evidence about the effectiveness of these models in real world settings compared to standard screening practices alone. Additionally, there is almost no guidance for their implementation in healthcare. The proposed project leverages the NIMH-funded Mental Health Research Network (MHRN), a collaboration of large health systems with established clinical data infrastructure to support multi-site studies. MHRN members Henry Ford Health System, Kaiser Permanente Northwest, and HealthPartners will participate in this project and collectively serve >170,000 behavioral health patients per year. The patient populations are diverse, including thousands of individuals with Medicaid and Medicare. Each of these systems has implemented a suicide prevention care model in their behavioral health departments, including robust suicide risk screening and assessment processes. However, none of these systems has implemented a suicide risk model. The proposed project includes a pragmatic trial approach with randomization of behavioral health clinics across the three participating health systems. It is innovative because it seeks to implement an MHRN suicide risk model (intervention) into each system's existing suicide prevention care model (usual care) to increase the reach and effectiveness of the suicide prevention care models. Sites will receive implementation planning support based on stakeholder feedback from preliminary studies and deliverables include an implementation planning tool kit to facilitate spread. This high-impact study has important clinical implications as health systems consider whether it makes sense to enhance their existing suicide prevention care models with a suicide risk model. It is timely because many health systems are advancing toward suicide risk model implementation without evidence to support this innovation.

项目摘要/摘要：自杀是美国的主要公共卫生问题；几乎每年有50,000人因自杀而死，近150万人自杀。迄今为止，识别有自杀风险的人依靠自杀风险筛查措施，包括使用各种自我报告工具。但是，这些措施的敏感性仅为中等。更精确的工具需要确定有自杀风险的患者。由我们的团队开发的自杀风险模型合并健康记录数据和历史自我报告筛查问卷回答以提高风险的准确性预言。我们的模型表现优于传统的临床筛查和成人的类似风险模型在门诊精神健康专业环境中接受护理。但是，虽然准确，但他们还没有在现实世界中评估；这些模型是实际增加识别还是导致患者接受尚不清楚更多的自杀预防服务，更少的危机服务或更少的自杀企图。那里在实施自杀风险模型方面具有很大的临床兴趣，但几乎没有科学证据与仅标准筛选实践相比，这些模型在现实世界中的有效性。此外，几乎没有指导他们在医疗保健中的实施。拟议的项目利用NIMH资助的心理健康研究网络（MHRN），这是大型健康的合作具有既定临床数据基础架构的系统，以支持多站点研究。 MHRN成员亨利福特卫生系统，Kaiser Permanente Northwest和HealthPartners将参加该项目，每年共同服务> 170,000名行为健康患者。患者人群多样化，包括成千上万的医疗补助和医疗保险。这些系统中的每一个都实现了其行为卫生部门的自杀预防护理模型，包括强大的自杀风险筛查和评估过程。但是，这些系统都没有实施自杀风险模型。这拟议的项目包括一种务实的试验方法，与行为健康诊所的随机分配三个参与的卫生系统。它具有创新性，因为它试图实施MHRN自杀风险模型（干预）进入每个系统现有的自杀预防护理模型（通常的护理），以增加自杀预防护理模型的覆盖范围和有效性。网站将收到实施计划基于初步研究和可交付成果的利益相关者反馈的支持包括实施计划工具套件以促进传播。这项高影响力的研究具有重要的临床意义系统考虑使用A增强现有的自杀预防护理模型是否有意义自杀风险模型。这是及时的，因为许多卫生系统正在朝着自杀风险模型前进实施没有证据支持这项创新。