A Comparative Effectiveness Trial of Strategies to Implement Firearm Safety Promotion as a Universal Suicide Prevention Strategy in Pediatric Primary Care

将枪支安全促进作为儿科初级保健中普遍自杀预防策略实施的策略的比较有效性试验

• 批准号: 10663829
• 负责人: Rinad Sary Beidas
• 金额: $ 64.97万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10663829
• 关键词: Academy; Accidents; American; Attitude; Behavior; Cessation of life; Childhood; Climate; Clinic; Clinical; Clinical Trials; Colorado; Consolidated Framework for Implementation Research; Control Groups; Counseling; Effectiveness; Electronic Health Record; Evidence based practice; Exposure to; Family; Feedback; Firearms; Funding; Future; Goals; Gun injury; Guns; Health system; Healthcare; Home; Hybrids; Intervention; Interview; Knowledge; Leadership; Medicine; Mental Health; Methods; Michigan; Names; National Institute of Mental Health; Outcome; Parents; Patient Self-Report; Patients; Pediatrics; Persons; Prevention strategy; Primary Care; Principal Investigator; Public Health; Randomized; Recommendation; Reporting; Research; Role; Safety; Secure; Suggestion; Suicide; Suicide attempt; Suicide prevention; System; Testing; Time; Training; United States; Visit; Work; Youth; acceptability and feasibility; behavior change; behavioral economics; clinical practice; cluster randomized design; comparative effectiveness trial; cost; design; effectiveness evaluation; effectiveness trial; effectiveness/implementation trial; evidence base; experience; extrinsic motivation; follow-up; future implementation; group intervention; implementation barriers; implementation efforts; implementation evaluation; implementation outcomes; implementation research; implementation strategy; implementation/effectiveness; improved; information gathering; insight; intrinsic motivation; mortality; pragmatic trial; prevent; primary care clinician; primary care setting; primary care visit; primary outcome; programs; provider behavior; safety and feasibility; safety testing; screening; secondary outcome; simulation; suicidal morbidity; suicidal risk; universal prevention

Program Director/Principal Investigator (Last, First, Middle): Beidas, Rinad Sary The proposed study will work to reduce firearm-related suicide deaths in young people by investigating the most effective way to implement a universal safe firearm storage program in pediatric primary care. The number of young people dying by suicide in the United States continues to rise, and risk for suicide death is much greater when there is an unlocked, loaded firearm in the home. A simulation study found that a modest increase in safe firearm storage could prevent up to 32% of firearm-related deaths in youth. Pediatric primary care is an ideal setting for universal suicide prevention strategies to reduce access to firearms, and prior research has shown that both health care clinicians and parents find firearm safety to be an appropriate topic to discuss, yet these conversations do not happen routinely. Safety Check, an evidence-based practice for firearm safety promotion that involves brief counseling and provision of a free cable lock, has been shown to double the odds of self-reported safe storage among parents but has not been implemented widely. Using feedback from pediatric clinicians, health system leaders, and firearm-owning parents regarding attitudes and barriers related to broader use of the program, the proposed study incorporates recommendations on how to boost the acceptability and feasibility of Safety Check for use as a universal suicide prevention strategy. Combining this feedback with insights from behavioral economics, we will conduct a hybrid type III effectiveness-implementation with a longitudinal cluster randomized design. The study will allow us to compare two approaches to implementing the program in pediatric primary care and evaluate the effectiveness of the adapted intervention, now named Gun Safe. The study will include 151 clinicians in 32 clinics who serve 38,989 youth annually in two MHRN health systems in Michigan and Colorado. All 32 clinics in the two participating health systems will receive Gun Safe materials, including brief training and cable locks. Half of the clinics (k = 16) will be randomized to receive the EHR implementation strategy (Nudge); the other half will be randomized to receive Nudge plus 1 year of facilitation to target additional clinician and organizational implementation barriers (Nudge+). We will collect the primary implementation outcome for 6 months before exposure to condition and for 1 year following to allow for comparisons between (a) the active and pre- exposure periods and (b) the active and sustainment periods. Results will guide future efforts to promote firearm safety as a universal suicide prevention strategy. In Aim 1, we will identify the effect of the implementation strategies on implementation outcomes (i.e., parent-reported clinician fidelity, reach (how many families received the intervention), cable lock distribution, acceptability, and cost). In Aim 2, we will also test potential implementation strategy mechanisms (i.e., how it worked). In Aim 3, we will examine clinical outcomes including a parent-reported safe storage behavior. This study can improve implementation of firearm safety interventions and identify the best approach to national implementation, with the ultimate goal of saving the lives of American youth, in alignment with NIMH Objective 4.

项目总监/首席研究员（最后，第一，中间）：Beidas，Rinad Sary 拟议的研究将通过调查该研究来减少年轻人的枪支相关自杀死亡。 在小儿初级保健中实施通用安全枪支存储计划的最有效方法。这 美国自杀死亡的年轻人人数继续增加，自杀死亡的风险是 当家里有解锁，装载的枪支时，要大得多。一项模拟研究发现谦虚 安全枪支存储的增加可能会阻止年轻人中多达32％的与枪支有关的死亡。小儿小学 护理是普遍预防自杀策略以减少枪支获取的理想场所，事先 研究表明，医疗保健临床医生和父母都认为枪支安全是一个适当的话题 讨论，这些对话并不是常规发生。安全检查，一种基于证据的实践 涉及简短咨询和提供免费电缆锁的枪支安全促销已被证明 父母自我报告的安全存储的几率增加了两倍，但尚未得到广泛实施。使用 儿科临床医生，卫生系统领导者和拥有枪支的父母的反馈 与该计划更广泛使用有关的障碍，拟议的研究结合了有关如何的建议 提高安全检查作为普遍预防自杀策略的可接受性和可行性。 将此反馈与行为经济学的见解相结合，我们将进行III型混合动力 具有纵向簇随机设计的有效实施。这项研究将使我们能够比较 在儿科初级保健中实施该计划的两种方法，并评估 改编干预措施，现在被称为Gun Safe。这项研究将包括151位服务的临床医生 密歇根州和科罗拉多州的两个MHRN卫生系统中，每年38,989名。这两个诊所的所有32个诊所 参与的卫生系统将获得枪支安全材料，包括简短的培训和电缆锁。一半 诊所（K = 16）将被随机分配以接受EHR实施策略（Nudge）；另一半将是 随机接受轻推加1年的便利设施，以瞄准其他临床医生和组织 实施障碍（Nudge+）。我们将在6个月之前收集主要实施结果 暴露于条件并在1年之后进行1年，以允许（a）主动和前的比较 暴露期以及（b）积极和维持期间。结果将指导未来的努力来促进 枪支安全作为普遍预防自杀策略。在AIM 1中，我们将确定 实施成果的实施策略（即，由父母报告的临床医生忠诚，触及到多少（多少 家庭接受了干预），电缆锁定分配，可接受性和成本）。在AIM 2中，我们还将测试 潜在的实施策略机制（即它的工作方式）。在AIM 3中，我们将检查临床 结果，包括父母报告的安全存储行为。这项研究可以改善枪支的实施 安全干预措施并确定最佳的国家实施方法，其最终目标是节省 美国青年的生活与NIMH目标4保持一致。

项目成果

Intersection of Surging Firearm Sales and COVID-19, Psychological Distress, and Health Disparities in the US-A Call for Action.

• DOI: 10.1001/jamanetworkopen.2020.34017
• 发表时间: 2021-01-04
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Hoskins K;Beidas RS
• 通讯作者: Beidas RS

Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care.

• DOI: 10.1186/s13012-021-01154-8
• 发表时间: 2021-09-22
• 期刊: Implementation science : IS
• 作者: Beidas RS;Ahmedani BK;Linn KA;Marcus SC;Johnson C;Maye M;Westphal J;Wright L;Beck AL;Buttenheim AM;Daley MF;Davis M;Elias ME;Jager-Hyman S;Hoskins K;Lieberman A;McArdle B;Ritzwoller DP;Small DS;Wolk CB;Williams NJ;Boggs JM
• 通讯作者: Boggs JM

Eight characteristics of rigorous multilevel implementation research: a step-by-step guide.

• DOI: 10.1186/s13012-023-01302-2
• 发表时间: 2023-10-23
• 期刊: IMPLEMENTATION SCIENCE
• 影响因子: 7.2
• 作者: Lengnick-Hall, Rebecca;Williams, Nathaniel J.;Ehrhart, Mark G.;Willging, Cathleen E.;Bunger, Alicia C.;Beidas, Rinad S.;Aarons, Gregory A.
• 通讯作者: Aarons, Gregory A.

Equitable implementation of S.A.F.E. Firearm: A multi-method pilot study.

公平实施 S.A.F.E.枪支：多方法试点研究。

• DOI: 10.1016/j.ypmed.2022.107281
• 发表时间: 2022-12
• 期刊: PREVENTIVE MEDICINE
• 影响因子: 5.1
• 作者: Hoskins, Katelin;Linn, Kristin A.;Ahmedani, Brian K.;Boggs, Jennifer M.;Johnson, Christina;Heintz, Jonathan;Marcus, Steven C.;Kaminer, Isabelle;Zabel, Celeste;Wright, Leslie;Quintana, LeeAnn M.;Buttenheim, Alison M.;Daley, Matthew F.;Elias, Marisa E.;Jager-Hyman, Shari;Lieberman, Adina;Lyons, Jason;Maye, Melissa;McArdle, Bridget;Ritzwoller, Debra P.;Small, Dylan S.;Westphal, Joslyn;Wolk, Courtney Benjamin;Zhang, Shiling;Shelton, Rachel C.;Beidas, Rinad S.
• 通讯作者: Beidas, Rinad S.