Telehealth to Improve Prevention of Suicide (TIPS) in EDs

远程医疗可改善急诊科的自杀预防 (TIPS)

• 批准号: 10532210
• 负责人: Edwin D Boudreaux
• 金额: $ 80.91万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10532210
• 关键词: Accident and Emergency department; Adherence; Adoption; Adverse event; Big Data; Caring; Cause of Death; Cessation of life; Clinical; Clinical Services; Communities; Computer software; Country; Data; Data Sources; Databases; Disease; Emergency Department patient; Emergency department visit; Environment; Evaluation; Feedback; Funding; Goals; Grant; Health; Health Technology; Healthcare; Healthcare Systems; Hospitalization; Hour; Improve Access; Incidence; Individual; Interruption; Intervention; Intervention Studies; Investigational Therapies; Knowledge; Massachusetts; Measures; Mediating; Mental Health; Methodology; Methods; Metric System; Modeling; Monitor; National Institute of Mental Health; Outcome; Patient-Focused Outcomes; Patients; Performance; Persons; Phase; Pragmatic clinical trial; Protocols documentation; Public Health; Quality of Care; Randomized; Research Design; Research Personnel; Resources; Risk; Risk Assessment; Role; Safety; Sampling; Series; Service delivery model; Services; Site; Specialist; Structure; Suicide; Suicide prevention; System; Telemental; Telephone; Time; Training; United States; United States National Institutes of Health; Visit; Wait Time; acute care; behavioral health; clinical care; comparative effectiveness; comparative effectiveness trial; cost; cost effectiveness; data resource; design; effectiveness/implementation trial; evidence base; follow-up; health care delivery; health care service; hospitalization rates; implementation barriers; implementation facilitators; implementation science; implementation strategy; improved; indexing; innovation; intervention effect; medical specialties; mental health center; patient stratification; patient subsets; provider behavior; reducing suicide; safety assessment; safety net; safety study; service delivery; service intervention; success; suicidal behavior; suicidal morbidity; suicidal risk; telehealth; translational model; treatment as usual; trend

ABSTRACT Significance: Our study will rigorously evaluate whether synchronous, within-visit telemental health evaluation and intervention services can successfully overcome poor access to behavioral health and substandard suicide-related care in emergency departments (EDs), including evaluating the impact on system metrics, a primary goal of RFA-MH-20-226. Notably, our study will surpass this primary requirement, because it will extend our understanding of the relative added value of the ED-SAFE post-visit telephone intervention and will create knowledge about key factors related to implementation and sustainment. Investigators: The team has extensive expertise in healthcare systems-based suicide prevention using continuous quality improvement implementation strategies (Boudreaux, Larkin, Miller), telehealth for behavioral health disorders (Boudreaux, Davis-Martin, Brown, Allen), using “big data” for outcome and intervention target ascertainment (Mathew, Liu, Li, Clements), and implementation science (Boudreaux, Larkin, Davis-Martin). Innovation: This will be the first study to evaluate telehealth for suicide prevention in the ED. It will use best- practices in both telemental health and suicide prevention and is designed for rapid dissemination. Our study design, an interrupted time series with a nested RCT and parallel Non-intervention control EDs, embodies cutting edge implementation science methodology. Our analyses are modeled after NIMH's experimental therapeutics paradigm, allowing us to evaluate intervention targets appropriate for healthcare service delivery studies. Approach: We will compare three conditions across two Intervention EDs that currently do not have on-site behavioral health specialists: (1) Treatment as usual (TAU), (2) Telehealth to Improve Prevention of Suicide (TIPS), which will include within-visit telehealth components only, and (3) TIPS+EDSAFE, which will include within- and post-visit components. Aim 1 will evaluate whether TIPS alone improves primary system metrics and suicide-related care practices compared to TAU. Aim 2 will compare 12-month patient outcomes, including a suicide composite outcome, across TAU, TIPS, and TIPS+EDSAFE. Aim 3 will evaluate factors related to implementation and sustainability, including costs. Two Non-intervention EDs will be monitored to control for macro system changes and secular trends. Existing big data sources, augmented by structured chart review, will be leveraged for efficient outcome ascertainment that maximizes sample representativeness. Environment: UMass has demonstrated its ability to support this study by its success with the NIMH-funded System of Safety (SOS) study, a Zero Suicide pragmatic clinical trial, in addition to its successful telehealth efforts funded through NIH and the Commonwealth of Massachusetts. Impact: The TIPS will address numerous fundamental questions around the role of telehealth in suicide prevention in a highly efficient, pragmatic clinical trial, maximizing the study's scientific and public health impact and building a singular database that will serve as an enduring resource to the suicide prevention community.

抽象的 意义：我们的研究将严格评估同步，访问远程健康状况是否 评估和干预服务可以成功地克服对行为健康的不良机会，并且 急诊科（EDS）中与自杀相关的护理不合格，包括评估对系统的影响 指标，RFA-MH-20-226的主要目标。值得注意的是，我们的研究将超过这一主要要求，因为它 将扩展我们对ED-SAFE访问后电话干预的相对附加值的理解， 将创建有关与实施和维持有关的关键因素的知识。 调查人员：该团队在使用医疗保健系统的自杀自杀方面拥有广泛的专业知识 持续质量改进实施策略（Boudreaux，Larkin，Miller），行为远程医疗 健康障碍（Boudreaux，Davis-Martin，Brown，Allen），使用“大数据”进行结果和干预目标 确定（Mathew，Liu，Li，Clements）和实施科学（Boudreaux，Larkin，Davis-Martin）。 创新：这将是第一个评估ED中预防自杀性远程医疗的研究。它将使用最好的 在远程健康和自杀预防方面的实践，专为快速传播而设计。我们的研究 设计是一个中断的时间序列，带有嵌套的RCT和平行的非干预控制ED，体现了切割 边缘实施科学方法论。我们的分析以NIMH的实验疗法进行建模 范式，使我们能够评估适合医疗服务提供研究的干预目标。 方法：我们将比较目前没有现场的两种干预ED中的三个条件 行为健康专家：（1）像往常一样治疗（tau），（2）远程医疗以改善自杀的预防 （提示），其中仅包括视野内远程医疗组件，以及（3）提示+EDSAFE，其中包括 视野内和访问后的组件。 AIM 1将评估单独提示是否改善主要系统指标和 与TAU相比，自杀相关的护理实践。 AIM 2将比较12个月的患者结果，包括 自杀复合结果，横跨tau，尖端和尖端+EDSAFE。 AIM 3将评估与 实施和可持续性，包括成本。将监视两项非干预ED，以控制 宏系统变化和世俗趋势。现有的大数据源，通过结构化图表审查增强， 将利用有效的结果确定，从而最大程度地提高样本代表性。 环境：UMass已经证明了其通过NIMH资助的成功来支持这项研究的能力 安全系统研究（SOS）研究，一项零自杀务实的临床试验，除了成功的远程医疗 通过NIH和马萨诸塞州联邦资助的努力。 影响：这些技巧将解决有关远程医疗在自杀中的作用的许多基本问题 在一项高效，务实的临床试验中预防，最大化研究的科学和公共卫生影响 并构建一个单数数据库，该数据库将作为预防自杀社区的持久资源。