Evaluating the Comparative Validity and Reliability of SERAS: A Decision Support Tool for Assessing Near Term Risk of Suicide in Emergency Departments.

项目摘要 在美国，每天自杀的人都比死于车祸的人多。NIMH的目标 零自杀倡议是预防那些正在接受医疗保健系统服务的人自杀。联合 委员会要求医院通过使用证据来减少医疗机构中的自杀事件- 基于筛选和评估。这一进程的一个基本要素是发展迅速但有效的 用于急诊室、危机诊所和其他急救设施的循证筛查仪。我们 系统性专家自杀风险评估（SERAS™）是一种基于神经网络的决策支持工具， 复制了经验丰富的临床医生在权衡风险因素方面的批判性思维， 个人近期自杀的风险。我们的第一阶段项目表明，SERAS™提供了相同的 基于临床医师的完整哥伦比亚自杀严重程度评定量表（CSSRS）的同期和预测效度 当在急诊室环境中使用时，花费的时间很少。我们在这个阶段有两个目标 二、应用。我们的第一个目标是将SEASTM集成到一个新的医疗保健系统电子工作流程中 健康记录，并确定其可接受性和可用性，当它取代目前的标准筛选。我们 预计SERASTM将具有良好到优秀的可用性，并将被容易地接受为易于使用， 有用的.我们的第二个目标是在整个医疗保健系统中大规模全面实施SERAS™ 并将其与针对低至中度风险筛查者的面对面或远程医疗二级评估配对。 通过将SERAS™实施到美国20家医院系统中的4家医院的标准临床工作流程中， 奥马哈，内布拉斯加州地区，并筛选超过100，000名成年人与SERAS™，我们将检查是否 两年来，该系统的自杀和与自杀有关的事件发生率有所下降。 该项目完成后将能够及时提供护理;它将提供高效和成本较低的保健服务; 它将加强对医疗保健系统中有风险的个人的监测;它将立即提供 通过确定有针对性的干预措施，为最终用户提供决策支持。我们为广告提供证据 通过详细的商业化计划，SERAS™的潜力表明，即使相对较低的 随着市场渗透率的提高，这一工具可以自我维持，以允许更多的循证筛查， 拯救更多的生命。

PROJECT SUMMARY Every day more people commit suicide than die from motor vehicle accidents in the US. The goal of the NIMH Zero Suicide Initiative is prevention of suicide among those being served by health care systems. The Joint Commission has mandated that hospitals reduce suicide in healthcare settings through the use of evidence- based screening and assessment. An essential element of this process is the development of rapid but effective evidence-based screeners for use in emergency rooms, crisis clinics, and other first responder facilities. Our Systematic Expert Risk Assessment of Suicide (SERAS™) is a neural-network-based decision support tool that replicates the critical thinking of experienced clinicians in weighing risk factors to prospectively assess an individual's near-term risk of suicide. Our Phase I project demonstrated that SERAS™ provides the same concurrent and predictive validity as a full clinician-based Columbia Suicide Severity Rating Scale (CSSRS) when used in an emergency department setting, yet takes a fraction of the time. We have two goals in this Phase II application. Our first goal is to integrate SERASTM into the workflow of a new healthcare system electronic health record and to establish its acceptability and usability when it replaces current standard screeners. We expect that SERASTM will have good-to-excellent usability and will be readily accepted as being easy to use and useful. Our second goal is to move SERAS™ to a large scale, full implementation across a healthcare system and pairing it with in-person or telehealth secondary assessments for those who screen at low to moderate risk. By implementing SERAS™ into the standard clinical workflow of 4 hospitals out of a 20 hospital system in the Omaha, Nebraska region, and screening more than 100,000 adults with SERAS™ we will examine whether there is a reduction in the incidence of suicide and suicide-related events in this system over a two-year period. This project, when complete will enable timely care; it will implement efficient and less costly healthcare delivery; it will enhance surveillance of individuals at risk within the healthcare system; and it will provide immediate decision support to the end user by identifying targeted interventions. We provide evidence for the commercial potential of SERAS™ through a detailed commercialization plan that demonstrates that, even with relatively low levels of market penetration, this tool can become self-sustaining to allow for more evidence-based screens and more lives saved.