Project 2: Managed care updates of subscriber justice system involvement for suicide prevention

项目 2：订户司法系统参与预防自杀的管理式护理更新

• 批准号: 10688249
• 负责人: Sarah A Arias
• 金额: $ 25.45万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-22 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10688249
• 关键词: Address; Admission activity; Adult; Algorithms; Appointment; Books; Budgets; Caring; Client; Community Healthcare; County; Data; Direct Costs; Drops; Effectiveness; Ensure; Ethics; Feeling suicidal; Funding; Future; General Population; Goals; Health; Health Care Visit; Health Services; Healthcare; Healthcare Systems; Hybrids; Individual; Information Systems; Injury; Inpatients; Instruction; Intervention; Investments; Jail; Justice; Lead; Legal; Letters; Life; Link; Managed Care; Mediator; Medicaid; Medical; Mental Health; Mental Health Services; Morbidity - disease rate; National Institute of Mental Health; Notification; Ohio; Outcome; Outcome Study; Outpatients; Persons; Poisoning; Population; Practice based research; Pregnant Women; Prevention Research; Prisons; Provider; Publishing; Randomized; Reporting; Research; Risk Assessment; Role; Running; Safety; Services; Suicide; Suicide attempt; Suicide prevention; Symptoms; System; Testing; Time; Training; Update; Vendor; behavioral health; care coordination; care fragmentation; clinical care; cost; cost effectiveness; design; evidence base; experience; implementation outcomes; implementation process; implementation strategy; implementation trial; improved; innovation; intervention effect; mortality; prevention practice; program costs; reducing suicide; research to practice; scale up; service member; service utilization; stressor; suicidal behavior; suicidal risk; suicide rate; treatment as usual

Abstract (PROJECT 2: Managed Care Updates) More than 10 million people pass through US jails each year. Suicide risk is especially high at jail release. Individuals are often arrested when they are out of care and experiencing worsening symptoms. Jail detention may disrupt existing care and provide additional stressors. However, high jail admission and discharge volumes (>10,000,000 per year), jail stays that only last a few days, and understaffing mean that most of the U.S.’s ~3,100 county and local jails do not have the capacity to coordinate care. Outside jail, many justice-involved individuals are supported by professionals in publicly funded systems, who are typically unaware that their client was in jail and may drop the client for missing appointments. The resulting lack of care or fragmented care leads to unnecessary cycling in and out of jail and suicide-related morbidity and mortality. Better coordination of care between county jails and healthcare systems is widely acknowledged as crucial but difficult to achieve at scale. To address this problem, a large Medicaid managed care organization (MCO; CareSource) and a justice data vendor partnered to track county jail booking and release data for Ohio CareSource through an algorithm using publicly available data, generalizable to other healthcare/MCOs. The goal was to help CareSource ensure that subscribers were connected to needed community care following jail release and to minimize disruptions of any existing care due to jail detention. MCOs like CareSource are ideal organizations to help address system fragmentation because they span multiple behavioral health (BH) care systems (400 in Ohio alone) and multiple county jails (~88 in Ohio alone). In 2019, 43,000 (5.4%) of CareSource’s 800,000 total adult subscribers in Ohio, including 2,306 pregnant women, spent time in jail. CareSource is exploring ways to ensure that these subscribers receive needed care. This proposal involves two studies of evidence-based suicide prevention practices triggered by CareSource justice notifications, in a 2x2 factorial design. The first study will randomize CareSource’s ~43,000 Ohio subscribers who pass through jails over 12 months to receive Caring Contact letters sent by CareSource or to Care as Usual. The second study (running simultaneously) will involve a subset of ~6,000 of the 43,000 subscribers passing through jail who were seen in one of 12 large BH agencies in the 6 months prior to jail detention. Using a stepped wedge design, the 12 agencies will be brought online over time, receiving (a) notifications of jail detentions/releases with instructions for re-engaging clients in services; and (b) training in the Safety Planning Intervention plus notification to use it when a subscriber with past medically treated suicide attempts (identified by CareSource through claims data) is released from jail. Outcomes include medically treated suicide attempts, all-cause injury and poisoning, service utilization, cost-effectiveness, and implementation data. This Hybrid Type I 2-year “Exploratory” Center project is fully powered, yielding definitive effectiveness results that can be scaled immediately to improve suicide prevention nationally.

摘要（项目 2：管理式医疗更新） 美国每年有超过 1000 万人在监狱里服刑，自杀风险尤其高。 个人经常在失去照顾并且症状恶化时被逮捕。 拘留可能会扰乱现有的护理并带来额外的压力，但入狱率和入狱率都很高。 出院量（每年超过 10,000,000 人）、监狱只能持续几天以及人手不足意味着 美国约 3,100 个县和地方监狱中的大多数没有能力协调监狱外的护理。 参与正义的个人得到公共资助系统中专业人员的支持，他们通常是 不知道他们的客户已入狱，并可能因错过预约而放弃客户，从而导致缺乏护理。 或分散的护理会导致不必要的循环进出监狱以及与自杀相关的发病率和死亡率。 县监狱和医疗保健系统之间更好的护理协调被广泛认为 为了解决这个问题，大型医疗补助管理医疗组织至关重要但难以大规模实现。 （MCO；CareSource）与一家司法数据供应商合作，跟踪俄亥俄州的县监狱预订和发布数据 CareSource 通过使用公开数据的算法，可推广到其他医疗保健/MCO。 目标是帮助 CareSource 确保订户在出狱后能够获得所需的社区护理 释放并尽量减少因监狱拘留而对现有护理造成的干扰，像 CareSource 这样的 MCO 是理想的选择。 组织帮助解决系统碎片化问题，因为它们涵盖多种行为健康 (BH) 护理 系统（仅俄亥俄州就有 400 个）和多个县监狱（仅俄亥俄州就有约 88 个），2019 年为 43,000 个（5.4%）。 CareSource 在俄亥俄州共有 800,000 名成年订阅者，其中包括 2,306 名孕妇，他们曾在监狱服刑。 CareSource 正在探索确保这些订阅者获得所需护理的方法。 该提案涉及两项基于证据的自杀预防实践的研究 CareSource 司法通知，采用 2x2 因子设计 第一项研究将对 CareSource 的随机化。 约 43,000 名俄亥俄州订户在入狱超过 12 个月后收到了 CareSource 或照常护理 第二项研究（同时进行）将涉及约 6,000 人的子集。 6 个月内，有 43,000 名入狱订阅者在 12 家大型 BH 机构之一露面 在监狱拘留之前，这 12 个机构将采用阶梯式楔形设计，随着时间的推移， 接收 (a) 监狱拘留/释放通知以及让客户重新参与服务的指示；以及 (b) 安全计划干预方面的培训以及当订阅者过去患有健康问题时使用它的通知 自杀未遂（CareSource 通过索赔数据确定）的结果包括出狱。 医疗治疗自杀未遂、全因伤害和中毒、服务利用、成本效益和 这个为期 2 年的混合型 I 型“探索”中心项目已全面启动并产生成果。 明确的有效性结果可以立即扩大规模，以改善全国范围内的自杀预防。