Effectiveness and Implementation of eScreening in Post 9/11 Transition Programs

9/11 后过渡计划中电子筛选的有效性和实施

• 批准号: 10242717
• 负责人: James Pittman
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10242717
• 关键词: Address; Adoption; Alcohols; Area; Caring; Case Manager; Clinical; Computer software; Data; Depressive disorder; Detection; Diagnosis; Diffusion; Documentation; Early Diagnosis; Early identification; Educational workshop; Effectiveness; Electronics; Enrollment; Evaluation; Evidence based practice; Feedback; Feeling suicidal; Goals; Health; Health system; Healthcare; Homogeneously Staining Region; Hybrids; Intervention; Interview; Maintenance; Managed Care; Managed Care Programs; Manuals; Medical Records; Mental Depression; Mental Health; Mental Health Associations; Mental Health Services; Mental disorders; Methodology; Methods; Names; Online Systems; Outcome; Paper; Patients; Performance; Phase; Pilot Projects; Positioning Attribute; Post-Traumatic Stress Disorders; Practical Robust Implementation and Sustainability Model; Process; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Risk; Site; Speed; Suicide; Suicide prevention; Symptoms; System; Technology; Testing; Time; Training; Veterans; Work; alcohol use disorder; clinical care; comparative; cost; design; effective therapy; effectiveness evaluation; effectiveness research; implementation efforts; implementation research; implementation science; implementation strategy; improved; innovation; military veteran; post 9/11; post intervention; pragmatic trial; process improvement; programs; research to practice; response; scale up; screening; screening program; suicidal behavior; suicidal risk; suicide rate; user centered design; verbal; web-based assessment

Background: Veterans disproportionately account for to 22% of all known suicides in the US. Screening for suicide risk at the first contact with an organization is a best practice in the national Zero Suicide framework and vital to enhancing access to appropriate care. Transition Care Management (TCM) programs are positioned to screen post-9/11 Veterans at the critical moment of enrollment in healthcare. Unfortunately, many Veterans who present for the first time in VHA with recent suicidal thoughts do not receive same day suicide risk evaluation (SRE), partly due to cumbersome screening processes. eScreening is a web-based Gold Standard Promising Practice electronic screening system with real-time scoring and integration into CPRS/VistA. Our eScreening effectiveness pilot in 1,372 post-9/11 Veterans and our 2-site multicomponent implementation strategy (MCIS) pilot showed increase speed and rate of SRE and sustainment of eScreening in two pilot sites. More research is warranted to test both. Significance/Impact: This proposal responds to HSR&D Priority Areas of: Suicide prevention, Increasing the real-world impact of research, and Implementation science. Our data will inform best practices in suicide prevention through early identification. This project will also allow for real-world integration of research into practice and inform implementation efforts for technology. Innovation: eScreening is a unique program developed with feedback from Veterans. To our knowledge, this is the first study to integrate VHA developed mobile patient-report screening technology to improve screening in TCM programs. It is also the first to examine the impact of electronic screening on rates of suicide risk evaluation and referral to care. Specific Aims: Aim 1. Evaluate the effectiveness of eScreening, compared to paper and verbal screening, on rate and speed of screening completion (suicide screening & evaluation, PTSD, depression, alcohol) and referral to mental health care in 8 TCM programs, guided by the RE-AIM outcomes of PRISM. Aim 2: Evaluate the feasibility, acceptability, and potential impact of the MCIS, guided by the RE-AIM outcomes of PRISM, adoption, implementation, and maintenance using mixed methods. We will also document and calculate replication costs across sites. Aim 3. Describe and compare high and low eScreening reach sites guided by contextual constructs of PRISM using qualitative comparative analysis to explore factors influencing the reach of eScreening and the use of the eScreening MCIS. Methodology: We propose an 8 site 4-year, stepped-wedge, mixed-method, Hybrid Type 2, pragmatic trial to compare eScreening to screening as usual while evaluating potential impact of the MCIS in TMC programs. Aim 1 outcomes will be collected via deidentified chart pull at the start and end of the pre-implementation phase, the 9-month intervention period, and 9-months post intervention. Aim 2 outcomes will be collected quantitatively from TCM staff questionnaires and qualitatively from interviews. Aim 3 data will be collected at the same intervals as Aim 2. Next Steps/Implementation: We will use the findings of this research to inform suicide prevention early identification best practices and enterprise scale-up of eScreening with our VACO partners.

背景：退伍军人不成比例地占美国所有已知自杀的22％。筛选 在与组织的第一次接触时，自杀风险是国家零自杀框架的最佳实践 对于增强获得适当护理的机会至关重要。过渡护理管理（TCM）计划是 在医疗保健注册的关键时刻，定位于9/11退伍军人。不幸的是，很多 退伍军人首次出席VHA，最近有自杀的想法并没有自杀 风险评估（SRE），部分是由于繁琐的筛选过程。 Escreening是基于网络的黄金 标准有希望的练习电子筛选系统，并将实时评分和集成到 CPRS/Vista。我们在1,372名退伍军人和我们的2个站点多组分的1,372名中的ESC效力飞行员 实施策略（MCIS）飞行员显示SRE的速度和速度增加以及Escreing的维持 在两个飞行员站点。有必要进行更多研究以测试这两者。意义/影响力：该提案回应 HSR＆D的优先领域：预防自杀，增加研究的实际影响和实施 科学。我们的数据将通过早期识别为预防自杀的最佳实践提供信息。这个项目将 还允许将研究整合到实践中并为技术的实施工作提供信息。 创新：Escreening是一个独特的计划，并以退伍军人的反馈意见开发。据我们所知，这个 是第一个集成VHA开发的移动患者报告筛查技术以改善筛选的研究 在TCM程序中。它也是第一个检查电子筛查对自杀风险率的影响 评估和推荐护理。具体目的：目标1。与 纸张和言语筛查，筛选完成速度和速度（自杀筛查和评估， PTSD，抑郁症，酒精）和在8个TCM计划中转介到精神卫生保健，在RE-AIM的指导下 棱镜的结果。目标2：评估MCI的可行性，可接受性和潜在影响 使用混合方法的棱镜，采用，实施和维护的结果。我们将 还记录并计算跨站点的复制成本。目标3。描述并比较高和低 通过定性比较分析以棱镜的上下文结构为指导 探索影响Escreing覆盖范围和使用ESCRENING MCIS的因素。方法论：我们 提出一个8年4年的8个站点，阶梯窗格，混合方法，杂种2，务实试验以比较 在评估MCI在TMC计划中的潜在影响时，像往常一样进行筛查。目标1 结果将通过在实施阶段的开始和结束时通过去识别图表拉动收集 干预后9个月的干预期和9个月。 AIM 2结果将被定量收集 来自TCM的员工问卷，并从定性上获取访谈。 AIM 3数据将在相同的 作为目标2。下一步/实施：我们将使用本研究的发现为自杀提供信息 预防早期识别最佳实践和与我们的Vaco合作伙伴的Escreing企业扩大规模。