Improving the Emergency Department Management of Deliberate Self-Harm

完善急诊科对故意自残的管理

基本信息

批准号：
9512435
负责人：
STEVEN C MARCUS
金额：
$ 12.03万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-01 至 2021-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9512435
关键词：
Accident and Emergency department Address Admission activity Adult American Hospital Association Caring Cessation of life Characteristics Communities Community Practice Community of Practice Consensus Data Collection Data Set Databases Development Effectiveness Emergency Care Emergency Medicine Emergency Situation Emergency medical service Environment Epidemiology Ethnography Evaluation Event General Hospitals Goals Health Care Costs Health Policy Health Services Accessibility Healthcare Healthcare Systems Hospitals Individual Information Services Injury Inpatients Intervention Interview Knowledge Longitudinal cohort study Medicaid Medical Medical emergency Mental Health Mental Health Services Methods Modeling Outcome Outpatients Patient risk Patient-Focused Outcomes Patients Performance Physician Executives Population Heterogeneity Probability Procedures Psychiatry Public Health Quality Indicator Records Research Research Methodology Risk Risk Assessment Role Safety Sampling Self-Injurious Behavior Services Site Specialist Suicide Suicide prevention Surveys Testing Time Triage United States United States Substance Abuse and Mental Health Services Administration Variant Work Youth cohort follow-up health care service utilization high risk improved indexing individual patient innovation insight multidisciplinary operation population based public health relevance statistics suicidal risk

项目摘要

DESCRIPTION (provided by applicant): Preventing suicide is one of the great public health challenges facing the US health care system. People who seek emergency care in general hospitals for deliberate self-harm are at exceptionally high short-term risk of repeated self-harm and suicide. Yet only about one-half of these patients receive emergency mental health evaluations. Among self-harm patients who are discharged to the community, only one-half receive follow-up outpatient mental health care in the following month. The proposed study will inform efforts to address deficiencies in the emergency management of deliberate self-harm by testing whether access to each of the following five emergency services influences inpatient admission, timely outpatient mental health care, short- term risk of repeated self-harm and suicide: 1) suicide risk assessment and triage procedures, 2) routine use of safety plans, 3) an on-site discharge planner, 4) an on-site or on-call mental health specialist, and 5) availability o crisis mental health services. The specific aims of the study are 1) to identify patient, hospital and service environment characteristics that influence access to these five emergency mental health services; 2) to determine whether access to each of these emergency mental health services influences inpatient admission, increases the likelihood of timely outpatient mental health follow-up care and reduces the short-term risk of deliberate self-harm and suicide, and 3) to understand qualitatively how these emergency mental health services operate in community practice. We will address these aims by extracting a sample of over ten thousand privately and Medicaid insured deliberate self-harm patients from approximately 500 emergency departments. At each of the treating hospitals, we will survey emergency medical directors to determine the presence or absence of the five emergency department services. Additional information about the emergency departments will be available from the Statewide Emergency Department Databases, hospital information will be available from the American Hospital Association Annual Survey, and regional mental health service information will be available from the Substance Abuse and Mental Health Services Administration surveys. Repeated deliberate self-harm will be assessed with administrative claims records and suicide will be determined by matching individual patients to the National Death Index. We will then use this patient, emergency department, hospital, and service environment information in propensity score adjusted models of the effects of the key emergency services on inpatient admission, follow-up outpatient mental health care, early repeated deliberate self-harm, and suicide. These issues will be examined in greater detail through qualitative interviews with key front line staff at selected emergency departments to probe how these services operate and what impedes their implementation in community practice. This new information will guide improvements in the emergency management of deliberate self-harm.

描述（由申请人提供）：预防自杀是美国医疗保健系统面临的重大公共卫生挑战之一。因故意自残而在综合医院寻求紧急护理的人短期内反复自残的风险极高。然而，这些患者中只有大约一半接受了紧急心理健康评估，而在出院的自残患者中，只有一半在接下来的一个月内接受了后续门诊心理健康护理。将告知解决问题的努力通过测试获得以下五种紧急服务是否会影响住院、及时门诊心理保健、反复自残和自杀的短期风险，来发现故意自残应急管理中的缺陷：1）自杀风险评估和分诊程序，2) 安全计划的常规使用，3) 现场出院计划员，4) 现场或待命的心理健康专家，以及 5) 危机心理健康服务的可用性研究的具体目标。是 1) 识别影响获得这五种紧急心理健康服务的患者、医院和服务环境特征 2) 确定获得这些紧急心理健康服务是否会影响患者入院、增加及时门诊心理健康后续护理的可能性并减少故意自残和自杀的短期风险，以及 3) 定性地了解这些紧急心理健康服务如何在社区实践中运作。我们将通过抽取一万多名私人和医疗补助保险的故意自我伤害样本来实现这些目标。约 500 名急诊患者受伤在每家治疗医院，我们将调查急诊医疗主任，以确定是否存在五个急诊科服务。有关急诊科的更多信息可从全州急诊科数据库中获取，医院信息可从以下位置获取。美国医院协会年度调查以及药物滥用和心理健康服务管理局调查中提供的区域心理健康服务信息将通过行政索赔记录进行评估，并通过将个别患者与自杀相关的信息进行匹配来确定自杀行为。然后我们将使用该患者的国家死亡指数。倾向评分调整模型中的科室、医院和服务环境信息对关键急诊服务对住院、后续门诊心理保健、早期反复故意自残和自杀的影响进行了更深入的研究。通过对选定的急诊部门的主要一线工作人员进行定性访谈来详细了解这些服务的运作方式以及阻碍其在社区实践中实施的因素。这些新信息将指导对故意自残的应急管理的改进。