Using the electronic health record to identify suicide risk factors in an Alaska Native Health System.
Using the electronic health record to identify suicide risk factors in an Alaska Native Health System.
复制标题
使用电子健康记录来识别阿拉斯加原住民卫生系统中的自杀风险因素。
DOI：
10.1037/ser0000492
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发表时间：
2022
影响因子：
2.3
通讯作者：
Shaw,JenniferL
中科院分区：
文献类型：
--
作者：
Schaefer,KristaR;Muller,ClemmaJ;Smith,JuliaJ;Avey,JaedonP;Shaw,JenniferL
一些阿拉斯加原住民和美洲印第安人社区的自杀率高于美国总人口。自杀风险筛查通常需要自我报告，但许多人可能因为不信任或不愿透露自杀想法而不进行常规筛查。需要对资源敏感的方法来检测自杀风险。这项研究确定了常规收集的电子健康记录数据，以确定与部落卫生保健系统中与自杀相关的访问相关的人口统计、临床和利用因素。在这项回顾性病例对照研究中，病例被定义为2012至2015年间与自杀相关的任何人。病例和对照按年龄、性别和城乡居住地进行匹配。我们使用条件Logistic回归来估计优势比，这被解释为基于罕见结果假设的患病率(PR)。数据集包括314个病例和1169个对照。在指数访问前一年，患者中毒或服药过量的患病率较高(PR=13.4，95%可信区间[3.5，51.7])，急诊科和急诊就诊(PR=15.8，95%CI[6.6，38.1])和住院(PR=4.5，95%CI[3.0，6.8])。电子健康记录可以用来识别那些可能没有被筛查标记的人中与自杀风险显著相关的因素。通过电子健康记录评估进行风险检测可能会在短期内增加临床工作量，但这种变化将被下游自杀相关事件的预防所抵消。这样的努力可以提高自杀风险的检测，并有助于改善阿拉斯加原住民和美国印第安人中与自杀相关的健康差距。(心理信息数据库记录(C)2022 APA，保留所有权利)
Suicide rates are higher in some Alaska Native and American Indian communities than the general US population. Screening for suicide risk typically requires self-report, but many people may not engage with conventional screening because of distrust or are reluctant to disclose thoughts of suicide. Resource-sensitive methods of detecting suicide risk are needed. This study identifies routinely collected electronic health record data to identify demographic, clinical, and utilization factors associated with suicide-related visits in a tribal health care system. In this retrospective, case-control study, cases were defined as any person with a suicide-related visit from 2012 to 2015. Cases and controls were matched by age, sex, and urban/rural residence. We used conditional logistic regression to estimate odds ratios, which were interpreted as prevalence ratios (PR) based on the rare outcome assumption. The dataset included 314 cases and 1,169 controls. In the year before the index visit, cases had higher prevalence of poisoning or overdose (PR= 13.4, 95% confidence interval [CI][3.5, 51.7]), emergency department and urgent care visits (PR= 15.8, 95% CI [6.6, 38.1]), and hospitalizations (PR= 4.5, 95% CI [3.0, 6.8]). Electronic health records can be used to identify factors that are significantly associated with suicide risk among those who may not be flagged by screening. Risk detection through electronic health record assessment might increase clinical workload in the short term, but this change would be offset by downstream prevention of suicide-related events. Such efforts could improve suicide risk detection and help to improve suicide-related health disparities in Alaska Native and American Indian populations.(PsycInfo Database Record (c) 2022 APA, all rights reserved)