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

• 批准号: 10441873
• 负责人: Brian Kenneth Ahmedani
• 金额: $ 43.82万
• 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/10441873
• 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; Emergency medical service; Feeling suicidal; Fissural; Funding; Future; General Population; Goals; Health; Health Services; Health Services Accessibility; Health Status; Health system; Healthcare; Healthcare Systems; Hybrids; Imprisonment; Individual; Infrastructure; Intercept; Intervention; Jail; Justice; Legal; Life; Link; Medicaid; Medicare; Mental Health; Michigan; Minnesota; National Institute of Mental Health; Outcome; Outpatients; Pathway interactions; Patients; Persons; Population; Population Heterogeneity; Prevention; Prevention approach; Process; Provider; Public Health; Randomized; Records; Reporting; Research; Risk; Safety; Sampling; Savings; Services; Site; Standardization; Structure; Substance Use Disorder; Suicide; Suicide attempt; Suicide prevention; System; Testing; Time; Trauma; United States; Vulnerable Populations; behavioral health; care coordination; care systems; community setting; coping; cost; cost effectiveness; data infrastructure; data integration; design; 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

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 随着美国自杀率持续上升，近5万人自杀死亡， 根据最近的数据，每年自杀未遂的情况越来越多地关注如何最好地整合， 协调多个部门的自杀风险识别和预防，其中一些最脆弱的 社区成员在持续的照顾中“从裂缝中掉出来”。也许没有地方需要 协调和整合比美国监狱系统的交叉点更明显，超过1000万 每年的入院人数，以及社区医疗保健系统;一个已知会影响个人的拦截， 自杀的风险极高。鉴于美国大约10%的自杀事件都是已知的， 在最近的刑事法律的压力源（通常是逮捕和监禁）之后发生的情况，减少了自杀 监狱拘留后一年的风险可能对全国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建立自杀风险护理途径， 在乎然而，这一过程一直受到数据和临床信息整合方面的主要裂缝的阻碍 监狱和卫生系统之间的差距，阻碍了这些社区部门之间的有效协调。 为了满足这些需求，拟议的签名项目是一个混合I型有效性实施试验 该公司将当地监狱预订和释放数据与两个大型医疗保健系统的医疗保健记录相协调， 明尼苏达州和密歇根州，以确定从监狱释放的卫生系统患者，并将数据配对 与随机分配到常规护理或多层次卫生系统自杀预防护理途径的联系 （包括护理协调、安全规划、护理联系人和远程医疗服务） 积极自杀计划（Active Suicide Program）在这样做的过程中，该项目利用了研究小组在卫生领域的经验， NIMH资助的心理健康研究网络中的系统数据链接， 选择了医疗保健系统，以及在监狱拘留期间预防自杀， 释放（即，在SPIRIT试验中），以及在基于电话的自杀预防干预中（即，在ED-SAFE中）。 拟议的项目将在两个地点随机选择1050人进行5S干预（相比之下， 超过60，000人在一个普通的护理无接触比较臂）。自杀未遂和死亡调查结果 结果，医疗保健利用机制，成本效益和实施因素将提供数据 以便将来在社区环境中进行全面的实施试验和广泛采用。特别是 拟议的签名项目将是第一个全面的卫生系统干预试验，以防止 因为病人的司法介入而自杀