Signature Project

宾夕法尼亚大学自杀预防创新实施研究(INSPIRE)中心的标志性项目 是一项大规模的研究研究，旨在检查以证据为基础的 在卫生保健环境中降低自杀风险的干预。该项目将利用方法学和 激励中心以优化实施为重点的行政支持实践性 针对少数群体和弱势群体的自杀预防干预。自杀风险高的个人 通常出现在急诊护理环境中，如急诊科(ED)，然后通常住院治疗 或转诊到门诊接受心理健康治疗。然而，尽管自杀行为的风险增加了， 自杀在急诊科就诊后，许多患者没有参加门诊治疗。简要-以证据为基础 安全规划干预和后续服务(SPI)等干预措施可用于缓解 这种风险会使患者在门诊接受治疗。然而，对于忙碌的人来说，这样的做法往往是具有挑战性的 急诊医生为有自杀倾向的患者提供服务。我们关于自杀、实施、健康的跨学科团队 服务、定性和定量研究人员以及急诊临床医生、健康 系统领导者、心理健康临床医生和患者将协作改进基于ED的交付 预防自杀的努力。我们提出了一种新的交付模式，在这种模式下，急诊科工作人员将连接有风险的患者 位于急诊科以外的精神健康临床医生自杀。这些非现场许可和认证 临床医生将在出院前通过远程医疗为ED患者提供SPI，并在出院后提供随访服务 ED出院是创新的预防自杀咨询中心(SPCC)的一部分。该项目有三个 明确的目标。目标1将使用阶梯楔形整群随机设计来评估SPI的有效性 SPCC临床医生通过远程医疗提供的费用与受过SPI培训的ED临床医生提供的SPI的费率比较 艾德出院后的自杀行为和参与护理。目标2将评估以下各项的执行情况 在关键实施方面，SPCC临床医生提供的SPI与ED临床医生提供的SPI进行比较 结果包括采用率、保真度、可接受性和可行性，还将探索临床医生的调解 意向、规范和自我效能感对SPI忠诚度的影响。目标3将评估ED和SPCC实践的成本 并检查医疗系统的潜在成本补偿，以提供SPCC可伸缩性和 可持续发展。如果成功并具有成本效益，在EDS之外使用SPCC可以成为一种可扩展的模式 为自杀高危人士提供以证据为本的预防自杀措施 有可能拯救生命的护理。

The Signature Project of the Penn Innovation in Suicide Prevention Implementation Research (INSPIRE) Center is a large-scale research study designed to examine the effectiveness and implementation of an evidence-based intervention to lower suicide risk in health care settings. The Project will leverage the methodological and administrative support of the INSPIRE Center with its focus on optimizing implementation of practice-based suicide prevention interventions for minority and disadvantaged populations. Individuals at high risk for suicide often present to acute care settings, such as emergency departments (EDs), and then typically are hospitalized or referred for outpatient mental health treatment. Yet, despite being at increased risk of suicidal behavior and suicide following an ED visit, many patients do not attend outpatient treatment. Brief evidenced-based interventions such as the Safety Planning Intervention and follow-up services (SPI+) are available to mitigate this risk and engage patients in outpatient treatment. However, such practices often can be challenging for busy ED clinicians to provide for suicidal patients. Our interdisciplinary team of suicide, implementation, health services, qualitative and quantitative researchers as well as diverse stakeholder groups of ED clinicians, health systems leaders, mental health clinicians, and patients will collaborate to improve the delivery of ED-based suicide prevention efforts. We propose a novel delivery model in which ED staff will connect patients at risk for suicide to mental health clinicians who are located external to the ED. These off-site licensed and credentialed clinicians will provide SPI+ via telehealth for ED patients prior to discharge and provide follow-up services after ED discharge as part of an innovative Suicide Prevention Consultation Center (SPCC). The Project has three Specific Aims. Aim 1 will use a stepped-wedge cluster-randomized design to evaluate the effectiveness of SPI+ delivered by SPCC clinicians via telehealth compared to SPI+ delivered by SPI+-trained ED clinicians on rates of suicidal behavior and engagement in care following ED discharge. Aim 2 will evaluate the implementation of SPI+ delivered by SPCC clinicians compared to SPI+ delivered by ED clinicians on key implementation outcomes including adoption, fidelity, acceptability, and feasibility and will also explore the mediation of clinician intentions, norms, and self-efficacy on the fidelity of SPI+. Aim 3 will evaluate the costs to ED and SPCC practices and examine potential cost offsets to the health system to provide evidence of SPCC scalability and sustainability. If successful and cost effective, use of a SPCC, external to EDs, could become a scalable model for providing suicide prevention evidenced-based practices to those at risk for suicide presenting for emergency care with the potential to save lives.