Signature Project

招牌项目

• 批准号: 10674625
• 负责人: Cynthia Ann Fontanella
• 金额: $ 74.77万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10674625
• 关键词: Academy; Acceleration; Accident and Emergency department; Address; Adolescent; American; Caring; Cause of Death; Cessation of life; Childhood; Clinical; Clinical Pathways; Clinical Trials; Communities; Community Practice; Detection; Effectiveness of Interventions; Evidence based intervention; Family; Feeling suicidal; Health Personnel; Health Professional; Healthy People 2020; Hybrids; Individual; Intervention; Intervention Studies; Interview; Knowledge; Low income; Managed Care; Mediating; Mediator; Mental Health; Modeling; Morbidity - disease rate; National Institute of Mental Health; Ohio; Outcome; Outcome Assessment; Outcome Measure; Pathway interactions; Patient-Focused Outcomes; Patients; Pediatrics; Phase; Pilot Projects; Prevention strategy; Primary Care; Process; Protocols documentation; Provider; Public Health; Randomized, Controlled Trials; Reporting; Research; Research Design; Risk; Risk Assessment; Risk Management; Risk Reduction; Safety; Self Efficacy; Service setting; Site; Strategic Planning; Suicide; Suicide attempt; Suicide prevention; Surveys; Testing; Time; Time trend; Triage; Youth; aged; clinical care; design; effectiveness evaluation; effectiveness research; effectiveness testing; effectiveness/implementation hybrid; effectiveness/implementation study; evidence base; follow-up; high risk population; implementation facilitators; improved; intervention effect; non-suicidal self injury; organizational readiness; pediatrician; population based; practice setting; preventive intervention; primary care clinician; primary care setting; recruit; reducing suicide; routine care; rural setting; satisfaction; screening; secondary outcome; suicidal behavior; suicidal morbidity; suicidal risk; therapy design; treatment as usual; treatment effect; urban setting

Suicide is the second leading cause of death in those aged 10 to 19 years; it is a critical public health problem. Suicidal ideation and nonfatal suicide attempts are even more prevalent and result in substantial morbidity and increased risk of suicide. Pediatric primary care is an ideal service setting for intervention research designed to rapidly reduce suicide and suicidal behaviors among US youth, as 80% of youth who die by suicide are seen by their primary care clinicians (PCC) in the year prior to death while only 20% have contact with a mental health professional. Despite the importance of identifying youth at risk for suicidal behavior, most PCCs do not routinely screen for suicide. In recent years, new treatment and management strategies have been developed, tested and implemented in some organizations, but they are not yet widely used. Existing clinical trials have tended to focus on testing effectiveness of evidenced-based interventions (e.g., universal screening, safety planning) for high-risk populations in emergency departments; less is known about the efficacy of these approaches in primary care settings. Research is critically needed to test the effectiveness of evidence-informed practices to reduce suicide risk for youth treated in primary care. To address this gap, we propose a stepped wedge hybrid effectiveness-implementation cluster-randomized controlled trial to test effectiveness of a population-based quality improvement (QI) intervention, Stepped Approach to Reducing Suicide in Primary Care (STARRS_PC) that implements a clinical pathway for youth identified by screening as being at elevated risk for suicide. The pathway is designed to promote the use of evidence-based suicide clinical care processes and includes three separate components: suicide risk screening, risk assessment and triage, and care management. The application builds on a pilot study of real- world implementation of suicide risk screening into a pediatric primary care setting, using an iterative Plan, Do, Study, Act (PDSA) quality improvement approach that was well-accepted by patients, families, and PCCs. In the proposed study, we will test the effectiveness of STARRS-PC relative to treatment as usual (TAU) on primary (suicidal attempts and suicide deaths), secondary outcomes (suicidal ideation, non-suicidal self-injury, and family satisfaction) at 3, 6, 12 months post-baseline; examine clinicians’ knowledge, self-efficacy, and buy- in regarding suicide risk screening, assessment, and management as mechanisms of change; and organizational factors (e.g., organizational readiness and practice integrations) as potential moderators of the treatment effect on patient outcomes During this five-year project, we will recruit and assess 2274 youth aged 12 to 17 years from 12 primary care sites, including 910 youths during the TAU phase and 1364 youths during the Screening + Intervention phase. Participating sites serve vulnerable low-income youth in urban and rural settings in central and southeastern Ohio.

自杀是10至19岁人群的第二大死因；它是一个严重的公共卫生问题。 自杀意念和非致命性自杀企图更加普遍，并导致相当大的发病率和 自杀风险增加。儿科初级保健是干预研究的理想服务环境，旨在 迅速减少美国青年中的自杀和自杀行为，80%的自杀青年被认为是自杀 死亡前一年的初级保健临床医生(PCC)，而只有20%的人与精神病患者有过接触 健康专业人士。尽管识别有自杀行为风险的青少年很重要，但大多数青少年社区并不这样做。 例行公事地筛查自杀。 近年来，新的治疗和管理策略被开发、测试和实施。 在一些组织中，但它们还没有被广泛使用。现有的临床试验倾向于集中于测试 以证据为基础的干预措施(如普遍筛查、安全规划)对高危人群的有效性 急诊科的人群；对这些方法在初级保健中的效果知之甚少 设置。迫切需要研究来测试循证实践的有效性，以减少 在初级保健中接受治疗的年轻人的自杀风险。 为了解决这一差距，我们提出了阶梯式楔形混合有效性-实现集群-随机化 以人群为基础的质量改进(QI)干预的有效性的对照试验，Step 实施青年临床路径的减少初级保健自杀的方法(STARRS_PC) 通过筛查确定为自杀风险较高的人。这条小径旨在促进使用 循证自杀临床护理流程，包括三个独立的组成部分：自杀风险 筛查、风险评估和分类，以及护理管理。该应用程序建立在对REAL-ARM的试点研究基础上 采用迭代计划，在儿科初级保健环境中实施自杀风险筛查， 研究，法案(PDSA)质量改进方法，被患者、家属和PCC广泛接受。在……里面 在拟议的研究中，我们将测试STARRS-PC相对于常规治疗(TAU)的有效性 主要结果(自杀未遂和自杀死亡)、次要结果(自杀意念、非自杀自残、 和家庭满意度)，在基线后3、6、12个月；检查临床医生的知识、自我效能和购买- 将自杀风险筛查、评估和管理视为改变的机制；以及 组织因素(例如，组织准备情况和实践整合)作为潜在的 治疗对患者预后的影响在这个五年计划中，我们将招募和评估2274名老年青年 12至17年，在12个初级保健地点，其中910名青年在TAU阶段，1364名青年在TAU阶段 筛查+干预阶段。参与网站为城乡弱势低收入青年提供服务 背景设在俄亥俄州中部和东南部。