Project 1: Syncing Screening and Services for Suicide Prevention across Health and Justice Systems

项目 1：跨卫生和司法系统同步预防自杀的筛查和服务

基本信息

批准号：
10688238
负责人：
Brian Kenneth Ahmedani
金额：
$ 104.5万
依托单位：
MICHIGAN STATE UNIVERSITY
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：
2022-08-22 至 2027-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10688238
关键词：
Address Admission activity Adoption Area Attention Awareness Books Caring Clinical Clinical Data Collaborations Communities Community Healthcare Comparison arm Continuity of Patient Care County Coupled Data Data Linkages Effectiveness of Interventions Eligibility Determination Emergency medical service Feeling suicidal Funding Future General Population Goals Health Health Services Health Services Accessibility Health Transition Health system Healthcare Healthcare Systems Hybrids Imprisonment Individual Infrastructure Intercept Intervention Jail Justice Legal Life Link Medicare/Medicaid Mental Health Michigan Minnesota National Institute of Mental Health Notification Outcome Outpatients Pathway interactions Patients Persons Population Population Heterogeneity Prevention Prevention approach Process Provider Public Health Randomized Records Reporting Research Risk Safety Sampling Services Site Standardization Structure Substance Use Disorder Suicide Suicide attempt Suicide prevention System Testing Trauma United States Vulnerable Populations behavioral health care coordination community setting coping cost cost effectiveness data infrastructure data integration design effectiveness evaluation effectiveness/implementation trial evidence base experience falls future implementation healing health care service utilization health care settings high risk implementation determinants implementation evaluation implementation outcomes implementation process implementation strategy implementation trial improved innovation inpatient service member metropolitan outreach patient population prevent preventive intervention programs recruit reducing suicide response screening stressor suicidal behavior suicidal morbidity suicidal risk suicide rate telehealth telephone based treatment arm treatment as usual trial design virtual vulnerable community

Address Admission activity Adoption Area Attention Awareness Books Caring Clinical Clinical Data Collaborations Communities Community Healthcare Comparison arm Continuity of Patient Care County Coupled Data Data Linkages Effectiveness of Interventions Eligibility Determination Emergency medical service Feeling suicidal Funding Future General Population Goals Health Health Services Health Services Accessibility Health Transition Health system Healthcare Healthcare Systems Hybrids Imprisonment Individual Infrastructure Intercept Intervention Jail Justice Legal Life Link Medicare/Medicaid Mental Health Michigan Minnesota National Institute of Mental Health Notification Outcome Outpatients Pathway interactions Patients Persons Population Population Heterogeneity Prevention Prevention approach Process Provider Public Health Randomized Records Reporting Research Risk Safety Sampling Services Site Standardization Structure Substance Use Disorder Suicide Suicide attempt Suicide prevention System Testing Trauma United States Vulnerable Populations behavioral health care coordination community setting coping cost cost effectiveness data infrastructure data integration design effectiveness evaluation effectiveness/implementation trial evidence base experience falls future implementation healing health care service utilization health care settings high risk implementation determinants implementation evaluation implementation outcomes implementation process implementation strategy implementation trial improved innovation inpatient service member metropolitan outreach patient population prevent preventive intervention programs recruit reducing suicide response screening stressor suicidal behavior suicidal morbidity suicidal risk suicide rate telehealth telephone based treatment arm treatment as usual trial design virtual vulnerable community

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项目摘要

PROJECT SUMMARY As suicide rates in the United States continue to rise, with nearly 50,000 suicide deaths and over 1 million suicide attempts annually per most recent data, increased attention has been paid to how to best integrate and coordinate suicide risk identification and prevention across multiple sectors, where some of our most vulnerable community members “fall through the cracks” in the continuum of care. Perhaps nowhere is this need for coordination and integration more pronounced than at the intersection of the US jail system, with over 10 million admissions per year, and the community healthcare system; an intercept known to impact individuals at disproportionately high risk for suicide. Given that roughly 10% of all suicides in the US with known circumstances occur following a recent criminal legal stressor (often arrest and jail detention), reducing suicide risk in the year after jail detention could have a noticeable impact on national suicide rates. There is thus a vital need to develop suicide risk care pathways between jails and healthcare systems to offer immediate access to care. Yet this process has been stymied by major fissures in the integration of data and clinical information between jails and health systems, preventing effective coordination of care between these community sectors. To address these needs, the proposed Signature Project is a Hybrid Type I effectiveness-implementation trial that harmonizes local jail booking and release data with healthcare records at two large healthcare systems in Minnesota and Michigan, to identify health system patients who are released from jail, and to pair the data linkage with randomization into usual care or a multi-level health system suicide prevention care pathway (consisting of care coordination, Safety Planning, Caring Contacts, and a telehealth delivered Coping Long- Term with Active Suicide Program). In so doing, this project leverages the study team’s experience in health system data linkage in the NIMH-funded Mental Health Research Network, from which the participating healthcare systems were chosen, as well as in suicide prevention around the period of jail detention and release (i.e., in the SPIRIT Trial), and in telephone-based suicide prevention intervention (i.e., in ED-SAFE). The proposed project will randomize 1050 individuals into the 5S intervention at both sites (comparing to more than 60,000 people in a usual care no contact comparison arm). Findings on suicide attempt and death outcomes, healthcare utilization mechanisms, cost- effectiveness, and implementation factors will provide data for a future fully scaled implementation trial and widespread adoption in community settings. Notably, the proposed Signature Project will be the first trial of a comprehensive health system intervention to prevent suicide in response to patients’ justice involvement.

项目摘要随着美国的自杀率继续上升，近50,000人自杀死亡，超过100万根据最新数据，每年的自杀企图每年都对如何最佳整合和协调自杀风险识别和预防多个部门，其中一些最脆弱的地方社区成员在护理的连续体中“陷入裂缝”。也许没有什么需要与美国监狱系统的交叉路口相比，协调和整合更为明显，超过1000万每年入学和社区医疗保健系统；已知会影响个人的拦截自杀的高风险不成比例。鉴于美国大约有10％的自杀在最近的刑事法律压力源（经常被捕和监禁）之后发生的情况，减少了自杀监狱拘留后的一年风险可能会对国家自杀率产生明显影响。因此有一个至关重要的需要在监狱和医疗保健系统之间发展自杀风险护理途径，以立即访问关心。然而，在数据和临床信息的整合中，重大裂缝阻碍了这个过程在监狱和卫生系统之间，防止这些社区部门之间有效协调护理。为了满足这些需求，拟议的签名项目是一项I型I型有效性试验在两个大型医疗保健系统中，将当地的监狱预订和发布数据与医疗保健记录发布明尼苏达州和密歇根州，以确定被释放的卫生系统患者，并配对数据将随机化与通常的护理或多层卫生系统自杀预防护理途径的联系（包括护理协调，安全计划，关怀联系人和远程医疗的应对长期带有主动自杀计划的术语）。这样一来，这个项目利用了研究团队在健康方面的经验 NIMH资助的心理健康研究网络中的系统数据链接，参与其中在监狱拘留期间和释放（即，在精神审判中）和基于电话的自杀预防干预措施（即在ED-SAFE中）。拟议的项目将将1050个人随机分配到两个站点的5S干预中（相比之下超过60,000人在通常的护理中没有接触比较部门）。关于自杀企图和死亡的发现结果，医疗保健利用机制，成本效益和实施因素将提供数据为了将来进行完全扩展的实施试验和社区环境中的广泛采用。值得注意的是拟议的签名项目将是全面的卫生系统干预措施的第一个试验，以防止自杀以应对患者的司法参与。