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%。 大多数自杀死亡者最后一次临床接触是在初级保健。ALACRITY中心 提出了3项研究，旨在帮助PCP利用青少年抑郁症的普遍筛查， 儿科初级保健的能力，以确定，分流，并管理抑郁症和自杀的青少年。到 促进对抑郁症或自杀倾向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），以指导PCP的治疗建议， 患者的敏锐度、障碍、态度和治疗偏好。提高低就诊率 在抑郁症筛查呈阳性的患者中，研究2开发并测试了一种个性化的短信， 针对患者和父母的动机、准备和障碍的干预。指导PCP 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， PCP制定安全计划并稳定自杀患者，从而避免不必要的转诊 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， 个人偏好、动机、障碍和临床表现的基础。这些干预措施 可能会产生很大的影响，因为抑郁症青少年的治疗依从性可能会增加一倍 高危人群自杀未遂率减半。我们将通过创新征求试点项目 为研究人员和利益相关者团队举办竞赛，探讨识别和降低自杀风险的新方法， 青少年，如使用数据挖掘的健康记录，以确定自杀青年，并评估自杀 通过分析语音和面部表情来评估风险。这些研究将在我们的CTSI支持的 儿科研究实践网络PittNet成功支持了许多心理健康研究 问题研究皮特雷促进了与儿科医生和其他利益攸关方的会议， 优先事项和相关研究，以便随后的产品将是有意义的，实用的，有用的， 临床医生和患者，并且极有可能被传播。该中心提供共享基础设施， 与利益攸关方的参与和合作，以及招聘、评估、技术 开发、数据管理和分析、获取电子健康记录和成本分析。我们的多学科团队 初级保健和心理健康专业人员，数据科学家和卫生服务研究人员 共同领导了9项NIH资助的初级保健心理健康干预试验，10项NIH资助的干预试验， 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， 测试技术以支持临床医生和患者。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，并建立一个合作伙伴关系。 致力于降低儿童初级保健中青少年自杀风险的网络。

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.