RFA-CE-22-004, Optimizing Firearm Suicide Prevention in Healthcare

自杀占美国枪支死亡的60%，阿拉斯加、科罗拉多州和 华盛顿。在美国，枪支是最常见的自杀方式，枪支的使用与 导致自杀风险增加。大多数自杀身亡的人在自杀前一年去看医疗服务提供者 死亡，因此临床提供者有重要的机会干预有枪支风险的患者 自杀。尽管枪支接触关系到患者的健康和安全，但有关枪支的常规问题 获取机会并不常见，而且缺乏现有证据来指导承诺的实施 预防枪支自杀的临床实践，包括枪支准入评估和提供者- 启动了关于限制访问的对话。我们的团队已经开始通过一系列的 创新研究的重点是枪支使用情况评估。具体地说，我们确定了那个成年人 初级保健和精神健康患者将回答有关枪支的标准化问题，以及 强调了将筛查问题限制在接受精神卫生保健的患者是如何错过了许多有风险的人 病人。我们还引起了患者和临床医生对枪支使用评估的关注，并描述了 他们的建议如何解决对隐私、自主权和所有权的担忧。 这项研究将建立在这些发现的基础上，并解决以患者为中心的战略的迫切需要 通过CDC的RFA-CE-CE目标之一识别和参与枪击自杀的高危患者 22-004：为创新和有希望的枪支伤害/死亡率的发展提供信息的研究 预防策略。以人为本的设计与社区参与式研究 办法将支持新的数据收集活动的备选方案B和实施 预防活动。我们将使用发现、设计和构建以及测试框架来 在三个医疗保健系统中实施战略，为社区约130万人提供服务 枪支拥有率和自杀率很高。我们会： 1(发现)：激发患者、临床医生和领导者对临床实践的看法，以确定 和接触有枪击自杀风险的人，并确定实践的机会 通过回顾图表和对病历的描述性分析进行改进。 2(设计/建造)：与临床和质量改进人员以及领导合作进行设计 支持以证据为基础的临床实践的干预战略，以预防枪支自杀。 3(测试)：在三个医疗保健系统中试点测试临床干预策略，以演示 可行性、可接受性和可用性；并衡量可及性。 我们的工作将为今后以患者为中心的枪击自杀的传播奠定坚实的基础 预防做法和有效性评估。

Suicide accounts for 60% of U.S. firearm deaths, with even higher rates in Alaska, Colorado, and Washington. Firearms are the most common method of suicide in the U.S., and firearm access is linked to increased suicide risk. Most people who die by suicide see a health care provider in the year prior to death, thus clinical providers have important opportunities to intervene with patients at risk for firearm suicide. Though firearm access is relevant to patients’ health and safety, routine questions about firearm access are uncommon and there is a dearth of evidence available to guide implementation of promising clinical practices for firearm suicide prevention, including firearm access assessment and provider- initiated dialogue about limiting access. Our team has begun to address this evidence gap in a series of innovative studies focused on firearm access assessment. Specifically, we established that adult primary care and mental health patients will answer standardized questions about firearms, and highlighted how limiting screening questions to patients receiving mental health care misses many at risk patients. We also elicited patient and clinician concerns about firearm access assessment and described how concerns about privacy, autonomy, and ownership rights may be addressed by their suggestions. This study will build on these findings and address the critical need for patient-centered strategies to identify and engage patients at high-risk of firearm suicide through Objective One of CDC’s RFA-CE- 22-004: Research to inform the development of innovative and promising firearm injury/mortality prevention strategies. Human Centered Design and Community Based Participatory Research approaches will support Option B for new data collection activities and the implementation of prevention activities. We will employ the Discover, Design and Build, and Test framework to inform implementation strategies in three healthcare systems serving ~1.3 million people in communities with high rates of firearm ownership and suicide. We will: 1 (DISCOVER): Elicit patient, clinician, and leader perspectives on clinical practices for identifying and engaging individuals at risk of firearm suicide, and to identify opportunities for practice improvement via retrospective chart review and descriptive analyses of medical records. 2 (DESIGN/BUILD): Partner with clinical and quality improvement staff and leadership to design intervention strategies to support evidence-based clinical practices for firearm suicide prevention. 3 (TEST): Pilot test clinical intervention strategies in three healthcare systems to demonstrate feasibility, acceptability, and usability; and to measure reach. Our work will lay a strong foundation for future dissemination of patient-centered firearm suicide prevention practices and evaluations of effectiveness.