Signature Project

招牌项目

基本信息

批准号：
10674625
负责人：
Cynthia Ann Fontanella
金额：
$ 74.77万
依托单位：
RESEARCH INST NATIONWIDE CHILDREN'S HOSP
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：
2022-08-01 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10674625
关键词：
Academy Acceleration Accident and Emergency department Address Adolescent American Caring Cause of Death Cessation of life Childhood Clinical Clinical Pathways Clinical Trials Communities Community Practice Detection Effectiveness of Interventions Evidence based intervention Family Feeling suicidal Health Personnel Health Professional Healthy People 2020 Hybrids Individual Intervention Intervention Studies Interview Knowledge Low income Managed Care Mediating Mediator Mental Health Modeling Morbidity - disease rate National Institute of Mental Health Ohio Outcome Outcome Assessment Outcome Measure Pathway interactions Patient-Focused Outcomes Patients Pediatrics Phase Pilot Projects Prevention strategy Primary Care Process Protocols documentation Provider Public Health Randomized, Controlled Trials Reporting Research Research Design Risk Risk Assessment Risk Management Risk Reduction Safety Self Efficacy Service setting Site Strategic Planning Suicide Suicide attempt Suicide prevention Surveys Testing Time Time trend Triage Youth aged clinical care design effectiveness evaluation effectiveness research effectiveness testing effectiveness/implementation hybrid effectiveness/implementation study evidence base follow-up high risk population implementation facilitators improved intervention effect non-suicidal self injury organizational readiness pediatrician population based practice setting preventive intervention primary care clinician primary care setting recruit reducing suicide routine care rural setting satisfaction screening secondary outcome suicidal behavior suicidal morbidity suicidal risk therapy design treatment as usual treatment effect urban setting

项目摘要

Suicide is the second leading cause of death in those aged 10 to 19 years; it is a critical public health problem. Suicidal ideation and nonfatal suicide attempts are even more prevalent and result in substantial morbidity and increased risk of suicide. Pediatric primary care is an ideal service setting for intervention research designed to rapidly reduce suicide and suicidal behaviors among US youth, as 80% of youth who die by suicide are seen by their primary care clinicians (PCC) in the year prior to death while only 20% have contact with a mental health professional. Despite the importance of identifying youth at risk for suicidal behavior, most PCCs do not routinely screen for suicide. In recent years, new treatment and management strategies have been developed, tested and implemented in some organizations, but they are not yet widely used. Existing clinical trials have tended to focus on testing effectiveness of evidenced-based interventions (e.g., universal screening, safety planning) for high-risk populations in emergency departments; less is known about the efficacy of these approaches in primary care settings. Research is critically needed to test the effectiveness of evidence-informed practices to reduce suicide risk for youth treated in primary care. To address this gap, we propose a stepped wedge hybrid effectiveness-implementation cluster-randomized controlled trial to test effectiveness of a population-based quality improvement (QI) intervention, Stepped Approach to Reducing Suicide in Primary Care (STARRS_PC) that implements a clinical pathway for youth identified by screening as being at elevated risk for suicide. The pathway is designed to promote the use of evidence-based suicide clinical care processes and includes three separate components: suicide risk screening, risk assessment and triage, and care management. The application builds on a pilot study of real- world implementation of suicide risk screening into a pediatric primary care setting, using an iterative Plan, Do, Study, Act (PDSA) quality improvement approach that was well-accepted by patients, families, and PCCs. In the proposed study, we will test the effectiveness of STARRS-PC relative to treatment as usual (TAU) on primary (suicidal attempts and suicide deaths), secondary outcomes (suicidal ideation, non-suicidal self-injury, and family satisfaction) at 3, 6, 12 months post-baseline; examine clinicians’ knowledge, self-efficacy, and buy- in regarding suicide risk screening, assessment, and management as mechanisms of change; and organizational factors (e.g., organizational readiness and practice integrations) as potential moderators of the treatment effect on patient outcomes During this five-year project, we will recruit and assess 2274 youth aged 12 to 17 years from 12 primary care sites, including 910 youths during the TAU phase and 1364 youths during the Screening + Intervention phase. Participating sites serve vulnerable low-income youth in urban and rural settings in central and southeastern Ohio.

自杀是 10 至 19 岁人群的第二大死因，是一个严重的公共卫生问题。自杀意念和非致命性自杀企图更加普遍，并导致大量的发病率和自杀风险增加的儿科初级保健是旨在进行干预研究的理想服务环境。迅速减少美国青少年的自杀和自杀行为，80% 的青少年死于自杀死亡前一年由他们的初级保健顾客 (PCC) 接触过，而只有 20% 的人与精神疾病有过接触尽管识别有自杀行为风险的青少年很重要，但大多数 PCC 并不这样做。自杀的常规筛查。近年来，已经开发、测试和实施了新的治疗和管理策略在一些组织中，但它们尚未广泛使用，现有的临床试验往往侧重于测试。针对高风险的循证干预措施（例如普遍筛查、安全规划）的有效性急诊科的人群；人们对这些方法在初级保健中的功效知之甚少迫切需要进行研究来测试以证据为依据的实践的有效性，以减少影响。在初级保健中接受治疗的青少年的自杀风险。为了解决这一差距，我们提出了一种阶梯楔形混合有效性-实施集群随机化测试基于人群的质量改进 (QI) 干预措施有效性的对照试验，阶梯式减少初级保健自杀的方法 (STARRS_PC)，为青少年实施临床路径通过筛选确定自杀风险较高的人。该途径旨在促进使用。基于证据的自杀临床护理流程，包括三个独立的组成部分：自杀风险该应用程序建立在真实的试点研究的基础上。使用迭代计划、执行、研究、行动 (PDSA) 质量改进方法受到患者、家属和 PCC 的广泛接受。在拟议的研究中，我们将测试 STARRS-PC 相对于常规治疗 (TAU) 的有效性主要结果（自杀企图和自杀死亡），次要结果（自杀意念、非自杀性自残、和家庭满意度）在基线后 3、6、12 个月检查专家的知识、自我效能和购买力；将自杀风险筛查、评估和管理视为变革机制；组织因素（例如组织准备度和实践整合）作为潜在的调节因素治疗对患者结果的影响在这个五年项目中，我们将招募并评估 2274 名青少年来自 12 个初级保健站点的 12 至 17 岁青少年，包括 TAU 阶段的 910 名青少年和 TAU 阶段的 1364 名青少年筛查+干预阶段的参与点为城乡低收入弱势青年提供服务。俄亥俄州中部和东南部的环境。