Effectiveness and Implementation of eScreening in Post 9/11 Transition Programs

9/11 后过渡计划中电子筛选的有效性和实施

• 批准号: 10242717
• 负责人: James Pittman
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10242717
• 关键词: Address; Adoption; Alcohols; Area; Caring; Case Manager; Clinical; Computer software; Data; Depressive disorder; Detection; Diagnosis; Diffusion; Documentation; Early Diagnosis; Early identification; Educational workshop; Effectiveness; Electronics; Enrollment; Evaluation; Evidence based practice; Feedback; Feeling suicidal; Goals; Health; Health system; Healthcare; Homogeneously Staining Region; Hybrids; Intervention; Interview; Maintenance; Managed Care; Managed Care Programs; Manuals; Medical Records; Mental Depression; Mental Health; Mental Health Associations; Mental Health Services; Mental disorders; Methodology; Methods; Names; Online Systems; Outcome; Paper; Patients; Performance; Phase; Pilot Projects; Positioning Attribute; Post-Traumatic Stress Disorders; Practical Robust Implementation and Sustainability Model; Process; Questionnaires; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Risk; Site; Speed; Suicide; Suicide prevention; Symptoms; System; Technology; Testing; Time; Training; Veterans; Work; alcohol use disorder; clinical care; comparative; cost; design; effective therapy; effectiveness evaluation; effectiveness research; implementation efforts; implementation research; implementation science; implementation strategy; improved; innovation; military veteran; post 9/11; post intervention; pragmatic trial; process improvement; programs; research to practice; response; scale up; screening; screening program; suicidal behavior; suicidal risk; suicide rate; user centered design; verbal; web-based assessment

Background: Veterans disproportionately account for to 22% of all known suicides in the US. Screening for suicide risk at the first contact with an organization is a best practice in the national Zero Suicide framework and vital to enhancing access to appropriate care. Transition Care Management (TCM) programs are positioned to screen post-9/11 Veterans at the critical moment of enrollment in healthcare. Unfortunately, many Veterans who present for the first time in VHA with recent suicidal thoughts do not receive same day suicide risk evaluation (SRE), partly due to cumbersome screening processes. eScreening is a web-based Gold Standard Promising Practice electronic screening system with real-time scoring and integration into CPRS/VistA. Our eScreening effectiveness pilot in 1,372 post-9/11 Veterans and our 2-site multicomponent implementation strategy (MCIS) pilot showed increase speed and rate of SRE and sustainment of eScreening in two pilot sites. More research is warranted to test both. Significance/Impact: This proposal responds to HSR&D Priority Areas of: Suicide prevention, Increasing the real-world impact of research, and Implementation science. Our data will inform best practices in suicide prevention through early identification. This project will also allow for real-world integration of research into practice and inform implementation efforts for technology. Innovation: eScreening is a unique program developed with feedback from Veterans. To our knowledge, this is the first study to integrate VHA developed mobile patient-report screening technology to improve screening in TCM programs. It is also the first to examine the impact of electronic screening on rates of suicide risk evaluation and referral to care. Specific Aims: Aim 1. Evaluate the effectiveness of eScreening, compared to paper and verbal screening, on rate and speed of screening completion (suicide screening & evaluation, PTSD, depression, alcohol) and referral to mental health care in 8 TCM programs, guided by the RE-AIM outcomes of PRISM. Aim 2: Evaluate the feasibility, acceptability, and potential impact of the MCIS, guided by the RE-AIM outcomes of PRISM, adoption, implementation, and maintenance using mixed methods. We will also document and calculate replication costs across sites. Aim 3. Describe and compare high and low eScreening reach sites guided by contextual constructs of PRISM using qualitative comparative analysis to explore factors influencing the reach of eScreening and the use of the eScreening MCIS. Methodology: We propose an 8 site 4-year, stepped-wedge, mixed-method, Hybrid Type 2, pragmatic trial to compare eScreening to screening as usual while evaluating potential impact of the MCIS in TMC programs. Aim 1 outcomes will be collected via deidentified chart pull at the start and end of the pre-implementation phase, the 9-month intervention period, and 9-months post intervention. Aim 2 outcomes will be collected quantitatively from TCM staff questionnaires and qualitatively from interviews. Aim 3 data will be collected at the same intervals as Aim 2. Next Steps/Implementation: We will use the findings of this research to inform suicide prevention early identification best practices and enterprise scale-up of eScreening with our VACO partners.

背景：退伍军人自杀人数占美国所有已知自杀人数的 22%。筛选 与组织第一次接触时的自杀风险是国家零自杀框架中的最佳实践 对于增加获得适当护理的机会至关重要。过渡护理管理 (TCM) 计划是 旨在在医疗保健登记的关键时刻筛查 9/11 后退伍军人。不幸的是，许多 首次出现在 VHA 且最近有自杀念头的退伍军人不会在同一天自杀 风险评估（SRE），部分原因是繁琐的筛选过程。 eScreening 是基于网络的黄金版 标准有前途的实践电子筛选系统，具有实时评分并集成到 CPRS/VistA。我们在 1,372 名 9/11 后退伍军人中进行了电子筛查有效性试点，并在 2 个站点进行了多组件测试 实施策略 (MCIS) 试点显示 SRE 的速度和比率有所提高以及电子筛选的维持 在两个试点地点。需要更多的研究来测试两者。意义/影响：该提案响应 HSR&D 优先领域：预防自杀、增加研究的现实影响以及实施 科学。我们的数据将通过早期识别为预防自杀的最佳实践提供信息。该项目将 还允许将研究与实践结合起来，并为技术的实施工作提供信息。 创新：eScreening 是根据退伍军人的反馈开发的一项独特计划。据我们所知，这 是第一项整合 VHA 开发的移动患者报告筛查技术以改善筛查的研究 在中医课程中。它还首次研究了电子筛查对自杀风险率的影响 评估和转诊护理。具体目标： 目标 1. 与相比，评估电子筛选的有效性 纸质和口头筛查，筛查完成率和速度（自杀筛查和评估， RE-AIM 指导下的 8 个中医项目中的创伤后应激障碍 (PTSD)、抑郁症、酒精）和转诊至心理健康护理 棱镜的结果。目标 2：评估 MCIS 的可行性、可接受性和潜在影响 使用混合方法的 PRISM、采用、实施和维护的 RE-AIM 结果。我们将 还记录并计算跨站点的复制成本。目标 3. 描述并比较高低 eScreening 通过 PRISM 上下文结构引导到达站点，使用定性比较分析来 探讨影响 eScreening 覆盖范围和 eScreening MCIS 使用的因素。方法论：我们 提出一项为期 4 年的 8 个地点、阶梯式楔形、混合方法、混合型 2、实用试验进行比较 电子筛查与往常一样进行筛查，同时评估 MCIS 在 TMC 计划中的潜在影响。目标1 结果将在预实施阶段开始和结束时通过去识别化的图表拉取来收集， 9个月的干预期和9个月的干预后。目标 2 结果将被定量收集 来自中医工作人员问卷调查和访谈定性。目标 3 数据将同时收集 目标 2 的间隔。后续步骤/实施：我们将利用本研究的结果来告知自杀 预防及早识别最佳实践，并与我们的 VACO 合作伙伴一起扩大电子筛查的企业规模。