Telehealth to Improve Prevention of Suicide (TIPS) in EDs

摘要 意义：我们的研究将严格评估是否同步，在访问远程健康 评估和干预服务可以成功地克服获得行为健康的机会少的问题， 急诊室（ED）中不合格的自杀相关护理，包括评估对系统的影响 指标，RFA-MH-20-226的主要目标。值得注意的是，我们的研究将超过这一基本要求，因为它 将扩展我们对ED-SAFE访视后电话干预的相对附加值的理解， 将创造有关执行和维持的关键因素的知识。 研究人员：该团队在基于医疗保健系统的自杀预防方面拥有广泛的专业知识， 持续质量改进实施策略（Boudreaux，Larkin，米勒），远程医疗行为 健康障碍（Boudreaux，Davis-Martin，Brown，艾伦），使用“大数据”进行结果和干预目标 确定（Mathew，Liu，Li，Clements）和实现科学（Boudreaux，Larkin，Davis-Martin）。 创新：这将是第一项评估远程医疗在急诊室预防自杀的研究。 在远程健康和自杀预防方面都有实践，并旨在快速传播。我们的研究 设计，一个中断的时间序列与嵌套RCT和并行非干预控制ED，体现切割 边缘实现科学方法论。我们的分析是仿照NIMH的实验疗法 范例，使我们能够评估干预目标适当的医疗服务提供的研究。 方法：我们将比较两个干预ED的三种情况，这些ED目前没有现场 行为健康专家：（1）治疗照常（TAU），（2）远程医疗，以改善预防自杀 （TIPS），仅包括访视内远程保健组件，以及（3）TIPS+EDSAFE，将包括 访视内和访视后部分。目标1将评估TIPS是否单独改善主要系统指标， 与TAU相比，自杀相关的护理实践。目标2将比较12个月的患者结局，包括 TAU、TIPS和TIPS+EDSAFE的自杀复合结局。目标3将评估与以下方面有关的因素： 执行和可持续性，包括费用。将监测两个非干预ED，以控制 宏观制度变迁和长期趋势。现有的大数据源，通过结构化图表审查得到增强， 将被用于最大化样本代表性的有效结果确定。 环境：麻省大学已经证明了它的能力，以支持这项研究的成功与NIMH资助的 安全系统（SOS）研究，一项零自杀实用临床试验，除了其成功的远程保健 这项工作由美国国立卫生研究院和马萨诸塞州联邦资助。 影响：TIPS将解决围绕远程医疗在自杀中的作用的许多基本问题 在一个高效，务实的临床试验中预防，最大限度地提高研究的科学和公共卫生影响 并建立一个单一的数据库，将作为一个持久的资源，自杀预防社区。

ABSTRACT Significance: Our study will rigorously evaluate whether synchronous, within-visit telemental health evaluation and intervention services can successfully overcome poor access to behavioral health and substandard suicide-related care in emergency departments (EDs), including evaluating the impact on system metrics, a primary goal of RFA-MH-20-226. Notably, our study will surpass this primary requirement, because it will extend our understanding of the relative added value of the ED-SAFE post-visit telephone intervention and will create knowledge about key factors related to implementation and sustainment. Investigators: The team has extensive expertise in healthcare systems-based suicide prevention using continuous quality improvement implementation strategies (Boudreaux, Larkin, Miller), telehealth for behavioral health disorders (Boudreaux, Davis-Martin, Brown, Allen), using “big data” for outcome and intervention target ascertainment (Mathew, Liu, Li, Clements), and implementation science (Boudreaux, Larkin, Davis-Martin). Innovation: This will be the first study to evaluate telehealth for suicide prevention in the ED. It will use best- practices in both telemental health and suicide prevention and is designed for rapid dissemination. Our study design, an interrupted time series with a nested RCT and parallel Non-intervention control EDs, embodies cutting edge implementation science methodology. Our analyses are modeled after NIMH's experimental therapeutics paradigm, allowing us to evaluate intervention targets appropriate for healthcare service delivery studies. Approach: We will compare three conditions across two Intervention EDs that currently do not have on-site behavioral health specialists: (1) Treatment as usual (TAU), (2) Telehealth to Improve Prevention of Suicide (TIPS), which will include within-visit telehealth components only, and (3) TIPS+EDSAFE, which will include within- and post-visit components. Aim 1 will evaluate whether TIPS alone improves primary system metrics and suicide-related care practices compared to TAU. Aim 2 will compare 12-month patient outcomes, including a suicide composite outcome, across TAU, TIPS, and TIPS+EDSAFE. Aim 3 will evaluate factors related to implementation and sustainability, including costs. Two Non-intervention EDs will be monitored to control for macro system changes and secular trends. Existing big data sources, augmented by structured chart review, will be leveraged for efficient outcome ascertainment that maximizes sample representativeness. Environment: UMass has demonstrated its ability to support this study by its success with the NIMH-funded System of Safety (SOS) study, a Zero Suicide pragmatic clinical trial, in addition to its successful telehealth efforts funded through NIH and the Commonwealth of Massachusetts. Impact: The TIPS will address numerous fundamental questions around the role of telehealth in suicide prevention in a highly efficient, pragmatic clinical trial, maximizing the study's scientific and public health impact and building a singular database that will serve as an enduring resource to the suicide prevention community.