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

项目概要/摘要：在美国，自杀是一个主要的公共卫生问题; 每年有5万人死于自杀，近150万人试图自杀。迄今为止， 有自杀风险的人依赖于自杀风险筛查实践，包括使用各种自我检查， 报告工具。然而，这些措施的敏感性只是中等;更精确的工具， 需要识别有自杀风险的患者。我们团队开发的自杀风险模型， 健康记录数据和历史自我报告筛选问卷回答，以提高风险的准确性 预测.我们的模型优于传统的临床筛查和类似的成人风险模型 在门诊心理健康专业机构接受治疗。然而，虽然准确，但它们并没有 在真实的世界护理中进行评估;模型是否实际上增加了识别或导致患者接受 更多的自杀预防服务，更少的危机服务，或更少的自杀企图是未知的。那里 在实施自杀风险模型方面有很大的临床兴趣，但很少有科学证据表明， 这些模型在真实的世界环境中与单独的标准筛选实践相比的有效性。 此外，在医疗保健方面几乎没有指导。拟建项目 利用NIMH资助的心理健康研究网络（MHRN），这是一个与大型健康机构合作的网络 具有已建立的临床数据基础设施的系统，以支持多中心研究。MHRN成员亨利 福特健康系统、Kaiser Permanente Northwest和HealthPartners将参与该项目， 每年为超过170，000名行为健康患者提供服务。患者群体是多样的， 包括数千名医疗补助和医疗保险的个人。这些系统中的每一个都实现了 行为健康部门的自杀预防护理模式，包括强有力的自杀风险筛查 和评估过程。然而，这些系统都没有实施自杀风险模型。的 拟议的项目包括一个务实的试验方法与随机的行为健康诊所， 三是参与卫生系统。它是创新的，因为它试图实施MHRN自杀风险 模式（干预）纳入每个系统现有的自杀预防护理模式（常规护理），以增加 自杀预防护理模式的覆盖范围和有效性。研究中心将收到实施计划 基于利益攸关方对初步研究的反馈的支持和可交付成果，包括实施 规划工具包，以促进传播。这项高影响力的研究具有重要的临床意义， 系统考虑是否有意义，以加强其现有的自杀预防护理模式， 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型迈进 没有证据支持这一创新。

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.