Evaluating Effectiveness and Implementation of a Risk Model for Suicide Prevention Across Health Systems

项目摘要/摘要：自杀是美国一个主要的公共卫生问题；几乎 每年有5万人死于自杀，近150万人自杀未遂。到目前为止，识别 有自杀风险的个人依赖于自杀风险筛查做法，包括使用各种自我评估 报告仪器。然而，这些措施的敏感性只是中等的；更精确的工具 识别有自杀风险的患者是必要的。由我们团队开发的自杀风险模型包括 健康记录数据和历史自我报告筛查问卷答复，以提高风险的准确性 预测。我们的模型优于传统的成人临床筛查和类似的风险模型。 在门诊精神卫生专科环境中接受治疗。然而，尽管它们是准确的，但它们并不准确 在现实世界的护理中进行评估；这些模型是否真的增加了认同感或导致患者接受 更多的自杀预防服务，更少的危机服务，或者更少的自杀企图是未知的。那里 临床上对实施自杀风险模型很感兴趣，但几乎没有科学证据表明 与单独使用标准筛查方法相比，这些模型在现实世界环境中的有效性。 此外，几乎没有关于它们在医疗保健中的实施的指导。拟议中的项目 利用NIMH资助的精神健康研究网络(MHRN)，这是一个大型健康组织的合作 具有已建立的临床数据基础设施以支持多站点研究的系统。MHRN成员亨利 福特健康系统、Kaiser Permanente Northwest和HealthPartners将参与该项目，并 每年总共为17万名行为健康患者提供服务。患者群体是不同的， 包括数千名拥有医疗补助和医疗保险的个人。其中每个系统都实现了 在他们的行为健康部门建立自杀预防护理模式，包括强有力的自杀风险筛查 和评估流程。然而，这些系统都没有实施自杀风险模型。这个 拟议的项目包括一种务实的试验方法，将行为健康诊所 三个参与的卫生系统。它是创新的，因为它寻求实施MHRN自杀风险 在每个系统现有的自杀预防护理模式(平时护理)中加入模式(干预)，以增加 自杀预防护理模式的可及性和有效性。各站点将收到实施规划 基于利益相关者对初步研究和交付成果的反馈提供的支持包括实施 规划工具包，便于推广。这项高影响力的研究具有重要的临床意义， 系统考虑是否有必要通过一个 自杀风险模型。这是及时的，因为许多卫生系统正在向自杀风险模式迈进 在没有证据支持这一创新的情况下实施。

PROJECT SUMMARY/ABSTRACT: Suicide is a major public health concern in the United States; nearly 50,000 individuals die by suicide annually and almost 1.5 million attempt suicide. To date, identification of individuals at risk for suicide has relied on suicide risk screening practices, including using a variety of self- report instruments. However, sensitivity of these measures are only moderate; more precise tools for identifying patients at risk for suicide are needed. Suicide risk models, developed by our team, incorporate health records data and historical self-report screening questionnaire responses to improve accuracy of risk prediction. Our models have outperformed traditional clinical screening and similar risk models for adults receiving care in outpatient mental health specialty settings. However, while accurate, they have not been evaluated in real world care; whether the models actually increase identification or result in patients receiving more suicide prevention services, fewer crisis services, or making fewer suicide attempts is unknown. There is substantial clinical interest in implementing suicide risk models but little scientific evidence about the effectiveness of these models in real world settings compared to standard screening practices alone. Additionally, there is almost no guidance for their implementation in healthcare. The proposed project leverages the NIMH-funded Mental Health Research Network (MHRN), a collaboration of large health systems with established clinical data infrastructure to support multi-site studies. MHRN members Henry Ford Health System, Kaiser Permanente Northwest, and HealthPartners will participate in this project and collectively serve >170,000 behavioral health patients per year. The patient populations are diverse, including thousands of individuals with Medicaid and Medicare. Each of these systems has implemented a suicide prevention care model in their behavioral health departments, including robust suicide risk screening and assessment processes. However, none of these systems has implemented a suicide risk model. The proposed project includes a pragmatic trial approach with randomization of behavioral health clinics across the three participating health systems. It is innovative because it seeks to implement an MHRN suicide risk model (intervention) into each system's existing suicide prevention care model (usual care) to increase the reach and effectiveness of the suicide prevention care models. Sites will receive implementation planning support based on stakeholder feedback from preliminary studies and deliverables include an implementation planning tool kit to facilitate spread. This high-impact study has important clinical implications as health systems consider whether it makes sense to enhance their existing suicide prevention care models with a suicide risk model. It is timely because many health systems are advancing toward suicide risk model implementation without evidence to support this innovation.