Project 1: Syncing Screening and Services for Suicide Prevention across Health and Justice Systems

项目 1：跨卫生和司法系统同步预防自杀的筛查和服务

基本信息

批准号：
10441873
负责人：
Brian Kenneth Ahmedani
金额：
$ 43.82万
依托单位：
MICHIGAN STATE UNIVERSITY
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：
2022-08-22 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10441873
关键词：
Address Admission activity Adoption Area Attention Awareness Books Caring Clinical Clinical Data Collaborations Communities Community Healthcare Comparison arm Continuity of Patient Care County Coupled Data Data Linkages Effectiveness of Interventions Emergency medical service Feeling suicidal Fissural Funding Future General Population Goals Health Health Services Health Services Accessibility Health Status Health system Healthcare Healthcare Systems Hybrids Imprisonment Individual Infrastructure Intercept Intervention Jail Justice Legal Life Link Medicaid Medicare Mental Health Michigan Minnesota National Institute of Mental Health Outcome Outpatients Pathway interactions Patients Persons Population Population Heterogeneity Prevention Prevention approach Process Provider Public Health Randomized Records Reporting Research Risk Safety Sampling Savings Services Site Standardization Structure Substance Use Disorder Suicide Suicide attempt Suicide prevention System Testing Time Trauma United States Vulnerable Populations behavioral health care coordination care systems community setting coping cost cost effectiveness data infrastructure data integration design effectiveness implementation trial evidence base experience falls future implementation healing health care service utilization health care settings high risk implementation determinants implementation evaluation implementation outcomes implementation process implementation strategy implementation trial improved innovation inpatient service member metropolitan outreach patient population prevent preventive intervention programs recruit reducing suicide response screening stressor suicidal behavior suicidal morbidity suicidal risk suicide rate telehealth telephone-based treatment arm treatment as usual trial design virtual vulnerable community

项目摘要

PROJECT SUMMARY As suicide rates in the United States continue to rise, with nearly 50,000 suicide deaths and over 1 million suicide attempts annually per most recent data, increased attention has been paid to how to best integrate and coordinate suicide risk identification and prevention across multiple sectors, where some of our most vulnerable community members “fall through the cracks” in the continuum of care. Perhaps nowhere is this need for coordination and integration more pronounced than at the intersection of the US jail system, with over 10 million admissions per year, and the community healthcare system; an intercept known to impact individuals at disproportionately high risk for suicide. Given that roughly 10% of all suicides in the US with known circumstances occur following a recent criminal legal stressor (often arrest and jail detention), reducing suicide risk in the year after jail detention could have a noticeable impact on national suicide rates. There is thus a vital need to develop suicide risk care pathways between jails and healthcare systems to offer immediate access to care. Yet this process has been stymied by major fissures in the integration of data and clinical information between jails and health systems, preventing effective coordination of care between these community sectors. To address these needs, the proposed Signature Project is a Hybrid Type I effectiveness-implementation trial that harmonizes local jail booking and release data with healthcare records at two large healthcare systems in Minnesota and Michigan, to identify health system patients who are released from jail, and to pair the data linkage with randomization into usual care or a multi-level health system suicide prevention care pathway (consisting of care coordination, Safety Planning, Caring Contacts, and a telehealth delivered Coping Long- Term with Active Suicide Program). In so doing, this project leverages the study team’s experience in health system data linkage in the NIMH-funded Mental Health Research Network, from which the participating healthcare systems were chosen, as well as in suicide prevention around the period of jail detention and release (i.e., in the SPIRIT Trial), and in telephone-based suicide prevention intervention (i.e., in ED-SAFE). The proposed project will randomize 1050 individuals into the 5S intervention at both sites (comparing to more than 60,000 people in a usual care no contact comparison arm). Findings on suicide attempt and death outcomes, healthcare utilization mechanisms, cost- effectiveness, and implementation factors will provide data for a future fully scaled implementation trial and widespread adoption in community settings. Notably, the proposed Signature Project will be the first trial of a comprehensive health system intervention to prevent suicide in response to patients’ justice involvement.

项目概要随着美国自杀率持续上升，自杀死亡人数近5万人，自杀人数超过100万根据最新数据，每年都有自杀企图，人们越来越关注如何最好地整合和协调多个部门的自杀风险识别和预防，其中一些最弱势群体社区成员在连续护理中“被忽视”，也许没有任何地方需要这种护理。协调和一体化比美国监狱系统的交叉点更加明显，超过 1000 万每年的入院人数和社区医疗保健系统；已知会影响个人的拦截鉴于美国大约 10% 的自杀事件是已知的。最近发生刑事法律压力（通常是逮捕和监禁）后发生的情况，减少自杀入狱后一年的风险可能会对全国自杀率产生显着影响。需要在监狱和医疗系统之间建立自杀风险护理通道，以便立即获得然而，这一过程因数据和临床信息整合方面的重大缺陷而受到阻碍。监狱和卫生系统之间的联系，阻碍了这些社区部门之间护理的有效协调。为了满足这些需求，拟议的签名项目是一项混合型 I 型有效性实施试验将当地监狱预订和发布数据与两个大型医疗系统的医疗记录相协调明尼苏达州和密歇根州，识别从监狱释放的卫生系统患者，并将数据配对与随机化纳入常规护理或多级卫生系统自杀预防护理途径的联系（包括护理协调、安全规划、护理联系人和远程医疗交付的应对长期在此过程中，该项目利用了研究团队在健康方面的经验。 NIMH 资助的心理健康研究网络中的系统数据链接，参与的选择了医疗保健系统，以及监狱拘留期间的自杀预防和释放（即在 SPIRIT 试验中）和基于电话的自杀预防干预（即在 ED-SAFE 中）。拟议项目将在两个地点随机抽取 1050 名个人进行 5S 干预（相比之下，更多超过 60,000 人在常规护理非接触比较组中的自杀未遂和死亡的调查结果。结果、医疗保健利用机制、成本效益和实施因素将提供数据以便未来在社区环境中进行全面的试验实施和广泛采用。拟议的签名项目将是综合卫生系统干预措施的首次试验，以预防为了回应患者的正义参与而自杀。