Rapid Referral to Suicide Specific Intervention in Psychiatric Emergency Care

精神科紧急护理中快速转诊针对自杀的干预措施

• 批准号: 10305695
• 负责人: Colin A. Depp
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10305695
• 关键词: Accident and Emergency department; Acute; Address; Ambulatory Care; Appointment; Area; Behavior; Caring; Clinic; Computerized Medical Record; Data; Day Care; Diagnosis; Diagnostic; Emergency Care; Evaluation; Evidence based intervention; Evidence based treatment; Feeling suicidal; Frequencies; Health Services Accessibility; Health Services Research; Homogeneously Staining Region; Hospitalization; Hybrids; Information Technology; Inpatients; Intervention; Joints; Managed Care; Management Information Systems; Measurement; Measures; Mediating; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Outcome; Outcome Measure; Outpatients; Persons; Prevention strategy; Provider; Psychotherapy; Randomized; Reporting; Research; Research Design; Research Methodology; Research Priority; Risk; Risk Factors; Risk Reduction; Schedule; Services; Severities; Site; Suicide; Suicide attempt; Suicide prevention; Tablets; Telephone; Time; Veterans; Walking; behavioral health; care coordination; clinical trial recruitment; evidence base; experience; follow-up; health information technology; high risk; hybrid type 1 design; improved; innovation; military veteran; novel; outreach; primary outcome; psychiatric emergency; randomized, clinical trials; recruit; secondary outcome; service coordination; stakeholder perspectives; suicidal; suicidal behavior; suicidal risk; suicide rate; treatment as usual; urgent care

This revised proposal responds to HSR&D's Targeted Solicitation for Health Services Research on Suicide Prevention. Same-day psychiatric emergency clinics are increasingly implemented and are a best practice in increasing access to mental health care and in suicide prevention. Our preliminary data indicate a high frequency of suicidal ideation and recent suicidal behavior among Veterans accessing same-day mental health evaluation, and yet fewer than half of Veterans with these risk factors engage in outpatient mental health appointments that are set following their initial acute evaluation. To reduce risk of suicide during the transition from acute to outpatient care, it is unclear if models that “bridge” the transition should emphasize telephone outreach, as delivered by Suicide Prevention Coordination teams, or suicide-specific psychotherapy, such as Collaborative Assessment and Management of Suicidality (CAMS). CAMS is a brief transdiagnostic evidence-based psychotherapy that is recognized by the Joint Commission and Zero Suicide Framework as indicated for Veterans experiencing active suicidal ideation and/or recent suicidal behavior. This single-site 4- year randomized clinical trial addresses pragmatic questions regarding the relative impact of rapid referral to CAMS versus compared to outreach delivered by Suicide Prevention Coordinators for Veterans who are accessing same day mental health evaluation and who are gauged to be at elevated risk for suicide. In a Hybrid Type 1 research design, we propose to recruit Veterans from the same-day clinic setting who report recent or current active suicidal ideation and/or suicide attempt within the past 3 months. Veterans will be randomized to timely initiation of CAMS or to telephone outreach from Suicide Prevention Coordinators. The primary outcome (Aim 1) is the 12-month rate of suicide-related behavior or psychiatric hospitalization. Aim 2 contrasts indicators of operational efficiency between randomized conditions, including Veterans' rate of missed appointments at referred ongoing mental health care and urgent care re-presentation. We will also evaluate secondary outcomes (e.g., suicidal ideation severity). Aim 3 will examine the mediating impact of outpatient mental health treatment engagement on primary outcomes. Aim 4 evaluates fidelity to CAMS and its association with outcomes. Fidelity and in-person outcomes are measured by use of information technology, called eScreening, that is integrated with the electronic medical record and is used coordinate rapid referral and measurement-based care. This project builds on our preliminary data which indicate that research recruitment and rapid referral to CAMS therapy in same-day setting is highly feasible, acceptable and potentially impactful. This project is innovative in its focus on transitional care interventions in the same day clinic setting and its integration of health information technology to facilitate rapid referral, extensible to the dissemination of other evidence-based treatments. This research directly responds to the National Prioritized Research Agenda for Suicide Prevention, which emphasizes a need for care models that deliver “suicide-specific intervention as soon as risk is identified” and addresses important gaps on the impact of timely suicide prevention strategies identified the White House report. The study also responds to the HSR&D Mental and Behavioral Health, Access, and Care Coordination Priority Areas. We expect that these data will inform best practices in suicide prevention in same day mental health services where many at-risk Veterans are seen.

该修订后的提案响应了 HSR&D 的自杀健康服务研究定向征集 预防。当天的精神科急诊诊所越来越多地实施，并且是以下国家的最佳实践： 增加获得精神卫生保健和预防自杀的机会。我们的初步数据表明 获得当天心理健康的退伍军人中自杀意念和近期自杀行为的频率 评估，但只有不到一半的具有这些危险因素的退伍军人参与门诊心理健康 在初步认真评估后确定的任命。为了减少自杀期间的风险 从急性护理到门诊护理的过渡，目前尚不清楚“桥梁”过渡的模型是否应该强调 由自杀预防协调小组提供的电话外展或针对自杀的心理治疗， 例如自杀倾向的协作评估和管理（CAMS）。 CAMS 是一种简短的跨诊断 联合委员会和零自杀框架认可的基于证据的心理治疗 适用于有活跃自杀意念和/或最近有自杀行为的退伍军人。这个单站点 4- 年随机临床试验解决了有关快速转诊的相对影响的实用问题 CAMS 与自杀预防协调员为退伍军人提供的外展活动进行比较 当天进行心理健康评估，并确定哪些人自杀风险较高。在混合动力中 类型 1 研究设计，我们建议从同一天的诊所招募退伍军人，他们报告最近或 过去 3 个月内当前有积极的自杀意念和/或自杀企图。退伍军人将被随机分配 及时启动 CAMS 或通过自杀预防协调员进行电话外展。初级 结果（目标 1）是 12 个月内自杀相关行为或精神​​病住院率。目标2 对比随机条件下的运营效率指标，包括退伍军人的比率 错过了转介的持续精神卫生保健和紧急护理再诊的预约。我们还将 评估次要结果（例如自杀意念的严重程度）。目标 3 将检验以下因素的中介影响： 门诊心理健康治疗对主要结局的影响。目标 4 评估对 CAMS 的保真度和 它与结果的关联。忠诚度和面对面的结果是通过使用信息来衡量的 称为 eScreening 的技术，与电子病历集成并用于协调快速 转诊和基于测量的护理。该项目建立在我们初步数据的基础上，这些数据表明研究 在同一天进行招募并快速转诊至 CAMS 治疗是高度可行、可接受和 潜在的影响力。该项目的创新之处在于其重点关注同一天的过渡性护理干预措施 诊所设置及其与健康信息技术的整合，以促进快速转诊，可扩展到 传播其他循证治疗方法。本研究直接响应国家优先重点项目 自杀预防研究议程，强调需要提供“针对自杀的护理模式” 一旦发现风险就进行干预”，并解决及时自杀影响方面的重要差距 白宫报告确定了预防策略。该研究还响应了 HSR&D 心理和 行为健康、获取和护理协调优先领域。我们希望这些数据能够提供最好的信息 当天心理健康服务中预防自杀的做法，其中有许多高危退伍军人。