Improving the Emergency Department Management of Deliberate Self-Harm

完善急诊科对故意自残的管理

基本信息

批准号：
9904783
负责人：
STEVEN C MARCUS
金额：
$ 67.03万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-05-01 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9904783
关键词：
Accident and Emergency department Address Admission activity Adult American Hospital Association Caring Cessation of life Characteristics Communities Community Practice Consensus Data Collection Data Set Databases Development Effectiveness Emergency Care Emergency Medicine Emergency Situation Emergency medical service Environment Epidemiology Ethnography Evaluation Event General Hospitals Goals Health Care Costs Health Policy Health Services Accessibility Health Services Research Healthcare Healthcare Systems Hospitals Individual Information Services Injury Inpatients Intervention Interview Knowledge Longitudinal cohort study Medicaid Medical Medical emergency Mental Health Mental Health Services Methods Modeling Outcome Outpatients Patient-Focused Outcomes Patients Performance Physician Executives Population Heterogeneity Probability Procedures Psychiatry Public Health Quality Indicator Records Research Research Methodology Risk Risk Assessment Role Safety Sampling Self-Injurious Behavior Service delivery model Services Site Specialist Suicide Suicide prevention Surveys Testing Time Triage United States United States Substance Abuse and Mental Health Services Administration Variant Work Youth cohort effectiveness evaluation follow-up health assessment health care service utilization high risk hospital services improved indexing individual patient innovation insight multidisciplinary operation population based public health relevance statistics suicidal risk

项目摘要

DESCRIPTION (provided by applicant): Preventing suicide is one of the great public health challenges facing the US health care system. People who seek emergency care in general hospitals for deliberate self-harm are at exceptionally high short-term risk of repeated self-harm and suicide. Yet only about one-half of these patients receive emergency mental health evaluations. Among self-harm patients who are discharged to the community, only one-half receive follow-up outpatient mental health care in the following month. The proposed study will inform efforts to address deficiencies in the emergency management of deliberate self-harm by testing whether access to each of the following five emergency services influences inpatient admission, timely outpatient mental health care, short- term risk of repeated self-harm and suicide: 1) suicide risk assessment and triage procedures, 2) routine use of safety plans, 3) an on-site discharge planner, 4) an on-site or on-call mental health specialist, and 5) availability o crisis mental health services. The specific aims of the study are 1) to identify patient, hospital and service environment characteristics that influence access to these five emergency mental health services; 2) to determine whether access to each of these emergency mental health services influences inpatient admission, increases the likelihood of timely outpatient mental health follow-up care and reduces the short-term risk of deliberate self-harm and suicide, and 3) to understand qualitatively how these emergency mental health services operate in community practice. We will address these aims by extracting a sample of over ten thousand privately and Medicaid insured deliberate self-harm patients from approximately 500 emergency departments. At each of the treating hospitals, we will survey emergency medical directors to determine the presence or absence of the five emergency department services. Additional information about the emergency departments will be available from the Statewide Emergency Department Databases, hospital information will be available from the American Hospital Association Annual Survey, and regional mental health service information will be available from the Substance Abuse and Mental Health Services Administration surveys. Repeated deliberate self-harm will be assessed with administrative claims records and suicide will be determined by matching individual patients to the National Death Index. We will then use this patient, emergency department, hospital, and service environment information in propensity score adjusted models of the effects of the key emergency services on inpatient admission, follow-up outpatient mental health care, early repeated deliberate self-harm, and suicide. These issues will be examined in greater detail through qualitative interviews with key front line staff at selected emergency departments to probe how these services operate and what impedes their implementation in community practice. This new information will guide improvements in the emergency management of deliberate self-harm.

描述（由适用提供）：防止自杀是美国卫生保健系统面临的巨大公共卫生挑战之一。在一般医院寻求急诊护理的人故意自我伤害的人出现反复自我伤害和自杀的短期风险。然而，这些患者中只有大约一半接受紧急心理健康评估。在被送往社区的自我伤害患者中，在接下来的一个月中，只有一半的人接受后续门诊精神卫生保健。拟议的研究将为解决以下五个紧急服务的访问是否会影响住院，及时的门诊精神卫生保健，反复自我伤害和自杀的短期风险，通过测试是否访问以下五个紧急服务来解决故意自我伤害的不足的努力，以告知努力：1）自杀风险评估和自杀计划，2）常规或统治计划。专家和5）可用性o危机心理健康服务。该研究的具体目的是1）确定影响进入这五项紧急心理健康服务的患者，医院和服务环境特征； 2）确定访问这些紧急心理健康服务中的每一种是否会影响住院入院，增加及时门诊精神健康后续护理的可能性，并减少故意自我伤害和自杀的短期风险，以及3）在定性上了解这些紧急心理健康在社区实践中如何运作。我们将通过从大约500个急诊室中提取超过一万私人的私人私人自我伤害患者来解决这些目标。在每家治疗医院，我们将调查急诊医疗董事，以确定五个急诊科服务的存在或不存在。有关急诊部门的其他信息，将从全州急诊室数据库中获得，医院信息将从美国医院协会年度调查中获得，区域心理健康服务信息将从毒品滥用和精神卫生服务管理局调查中获得。重复的故意自我伤害将通过行政索赔记录进行评估，并通过将个别患者与国家死亡指数相匹配来确定自杀。然后，我们将使用该患者，急诊室，医院和服务环境信息在Promise评分的调整模型中，这些模型是关键的紧急服务对住院入院，后续门诊门诊精神卫生保健的影响，早期重复刻意自我伤害和自杀。这些问题将通过与选定急诊部门的主要前线员工进行定性访谈，以探讨这些服务的运作方式以及阻碍其在社区实践中实施的原因，从而更详细地研究这些问题。这些新信息将指导故意自我伤害的紧急管理的改进。