The Center for Enhancing Triage and Utilization for Depression and Emergent Suicidality (ETUDES) in Pediatric Primary Care

概述摘要 自杀是青少年死亡的第二大原因，在过去十年中增加了20%。 大多数自杀死者的最后一次临床接触是在初级保健服务中。这家快活中心 提出了3项旨在帮助初级保健医生利用普遍筛查青少年抑郁症的研究，通过加强 儿科初级保健识别、分类和管理抑郁和自杀青少年的能力。至 促进对抑郁或自杀筛查呈阳性的青少年采取一致的最佳做法， 研究1开发了一个决策支持系统(DSS)来指导PCP的治疗建议，以反映 患者的敏锐度、障碍、态度和治疗偏好。提高低就诊率 在对抑郁症筛查呈阳性的患者中，研究2开发并测试了个性化短信 以患者和家长的动机、准备和障碍为目标的干预。指导初级保健医生 通过常规筛查识别自杀青少年，研究3开发并测试了一款应用程序，以指导 PCP制定安全计划并稳定自杀患者的病情，从而避免不必要的转介到 艾德和医院。这些研究是创新的，通过使用技术来个性化干预 个人喜好、动机、障碍和临床表现的基础。这些干预措施是 这可能会产生很大的影响，可能会使抑郁症青少年的治疗依从率翻一番 并将高危人群的自杀未遂率减半。创新征集试点。 为调查团队和利益相关者举办的关于识别和减少自杀风险的新方法的竞赛 青少年，如利用数据挖掘的健康记录来识别有自杀倾向的青少年，并评估自杀 通过分析语音和面部表情来确定风险。这些研究将在我们由CTSI支持的 儿科研究实践网络，它成功地支持了许多心理健康研究 学习。PittNet促成了与儿科医生和其他利益相关者的会议，以协作开发这些 优先事项和相关研究，以便后续产品将有意义、实用、对 临床医生和患者，并极有可能传播。该中心为 与利益攸关方的接触和协作，以及招聘、评估、技术 开发、数据管理和分析、获取企业人力资源和成本分析。我们的多学科团队 初级保健和精神卫生专业人员、数据科学家和卫生服务研究人员 共同领导了9项由NIH资助的初级保健心理健康干预试验，10项由NIMH资助的干预试验 针对情绪障碍和自杀青少年的开发或临床试验，以及7项NIH赠款，这些资金开发和 测试支持临床医生和患者的技术。该团队拥有丰富的合作经验 利益相关者，管理研究中心，培训早期职业科学家，并打造协作性 致力于减少儿科初级保健中的青年自杀风险的网络。

Overview Abstract Suicide is the 2nd leading cause of death among adolescents and has increased by 20% in the past decade. The majority of suicide decedents have their last clinical contact in primary care. This ALACRITY Center proposes 3 studies designed to help PCPs capitalize on universal screening for teen depression by enhancing pediatric primary care’s capacity to identify, triage, and manage depressed and suicidal adolescents. To promote a consistent, best practice approach to adolescents who screen positive for depression or suicidality, Study 1 develops a decision support system (DSS) to guide PCPs’ treatment recommendations to reflect patient acuity, barriers, attitudes, and treatment preferences. To increase the low rate of treatment attendance among patients who screen positive for depression, Study 2 develops and tests a personalized texting intervention that targets patient and parent motivation, readiness, and barriers. To guide PCPs upon identification of suicidal adolescents through routine screening, Study 3 develops and tests an app to guide the PCP to develop a safety plan and stabilize the suicidal patient, thereby avoiding unnecessary referrals to the ED and hospital. These studies are innovative through their use of technology to personalize interventions on the basis of personal preferences, motivations, barriers, and clinical presentation. These interventions are likely to be of high impact, by potentially doubling the rate of treatment adherence in depressed adolescents and halving the rate of suicide attempts in those at high risk. We will solicit pilot projects through innovation contests for teams of investigators and stakeholders on novel methods to identify and reduce suicidal risk in adolescents, such use of data mining of health records to identify suicidal youth, and assessment of suicide risk via analysis of speech and facial expression. These studies will be conducted in our CTSI-supported pediatric research practice network, PittNet, which has successfully supported many mental health research studies. PittNet facilitated meetings with pediatricians and other stakeholders to collaboratively develop these priorities and associated studies, so that the ensuing products would be meaningful, practical, useful to clinicians and patients, and highly likely to be disseminated. This Center provides shared infrastructure for the engagement and collaboration with stakeholders, as well as for recruitment, assessment, technology development, data management and analysis, access to EHRs and costs analyses. Our multidisciplinary team of primary care and mental health professionals, data scientists, and health services researchers has collectively led 9 NIH funded trials of mental health interventions in primary care, 10 NIMH-funded intervention development or clinical trials for mood disordered and suicidal adolescents, and 7 NIH grants that develop and test technologies to support clinicians and patients. This team has extensive experience collaborating with stakeholders, managing research centers, and training early career scientists and forges a collaborative network dedicated to the reduction of youth suicide risk in pediatric primary care.