A Comparative Effectiveness Trial of Strategies to Implement Firearm Safety Promotion as a Universal Suicide Prevention Strategy in Pediatric Primary Care

将枪支安全促进作为儿科初级保健中普遍自杀预防策略实施的策略的比较有效性试验

• 批准号: 10715802
• 负责人: Rinad Sary Beidas
• 金额: $ 72.2万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10715802
• 关键词: Comparative; Effectiveness; Trial; Strategies; Implement

Program Director/Principal Investigator (Last, First, Middle): Beidas, Rinad Sary The proposed study will work to reduce firearm-related suicide deaths in young people by investigating the most effective way to implement a universal safe firearm storage program in pediatric primary care. The number of young people dying by suicide in the United States continues to rise, and risk for suicide death is much greater when there is an unlocked, loaded firearm in the home. A simulation study found that a modest increase in safe firearm storage could prevent up to 32% of firearm-related deaths in youth. Pediatric primary care is an ideal setting for universal suicide prevention strategies to reduce access to firearms, and prior research has shown that both health care clinicians and parents find firearm safety to be an appropriate topic to discuss, yet these conversations do not happen routinely. Safety Check, an evidence-based practice for firearm safety promotion that involves brief counseling and provision of a free cable lock, has been shown to double the odds of self-reported safe storage among parents but has not been implemented widely. Using feedback from pediatric clinicians, health system leaders, and firearm-owning parents regarding attitudes and barriers related to broader use of the program, the proposed study incorporates recommendations on how to boost the acceptability and feasibility of Safety Check for use as a universal suicide prevention strategy. Combining this feedback with insights from behavioral economics, we will conduct a hybrid type III effectiveness-implementation with a longitudinal cluster randomized design. The study will allow us to compare two approaches to implementing the program in pediatric primary care and evaluate the effectiveness of the adapted intervention, now named Gun Safe. The study will include 151 clinicians in 32 clinics who serve 38,989 youth annually in two MHRN health systems in Michigan and Colorado. All 32 clinics in the two participating health systems will receive Gun Safe materials, including brief training and cable locks. Half of the clinics (k = 16) will be randomized to receive the EHR implementation strategy (Nudge); the other half will be randomized to receive Nudge plus 1 year of facilitation to target additional clinician and organizational implementation barriers (Nudge+). We will collect the primary implementation outcome for 6 months before exposure to condition and for 1 year following to allow for comparisons between (a) the active and pre- exposure periods and (b) the active and sustainment periods. Results will guide future efforts to promote firearm safety as a universal suicide prevention strategy. In Aim 1, we will identify the effect of the implementation strategies on implementation outcomes (i.e., parent-reported clinician fidelity, reach (how many families received the intervention), cable lock distribution, acceptability, and cost). In Aim 2, we will also test potential implementation strategy mechanisms (i.e., how it worked). In Aim 3, we will examine clinical outcomes including a parent-reported safe storage behavior. This study can improve implementation of firearm safety interventions and identify the best approach to national implementation, with the ultimate goal of saving the lives of American youth, in alignment with NIMH Objective 4.

项目负责人/主要研究者（最后，第一，中间）：Beidas，Rinad Sary 这项拟议中的研究将通过调查年轻人中与枪支有关的自杀死亡人数， 在儿科初级保健中实施普遍安全枪支储存计划的最有效方法。的 在美国，自杀死亡的年轻人数量继续上升，自杀死亡的风险正在增加。 当家里有一把未上锁的上膛的枪时，这种情况就更严重了。一项模拟研究发现， 增加枪支安全储存可以防止高达32%的与枪支有关的青年死亡。小儿原发性 护理是普遍自杀预防战略的理想环境，以减少获得枪支的机会， 研究表明，卫生保健临床医生和家长都认为枪支安全是一个适当的话题， 然而，这些对话并不经常发生。安全检查，一种基于证据的做法， 涉及简短咨询和提供免费电缆锁的枪支安全宣传已被证明， 父母自我报告的安全储存的几率增加了一倍，但尚未广泛实施。使用 来自儿科临床医生、卫生系统领导和拥有枪支的父母的反馈， 与更广泛地使用该计划有关的障碍，拟议的研究纳入了关于如何 提高安全检查作为普遍预防自杀策略的可接受性和可行性。 结合这些反馈和行为经济学的见解，我们将进行混合型III 有效性-采用纵向群集随机设计实施。这项研究将使我们能够比较 两种方法来实施该计划在儿科初级保健和评估的有效性， 适应性干预，现在称为枪支安全。这项研究将包括32个诊所的151名临床医生， 密歇根州和科罗拉多州的两个MHRN卫生系统每年有38,989名青年。两个城市的32个诊所 参与的卫生系统将收到枪支安全材料，包括简短的培训和电缆锁。半年 诊所（k = 16）将随机接受EHR实施策略（Nudge）;另一半将 随机接受Nudge +1年促进，以针对其他临床医生和组织 实施障碍（Nudge+）。我们将收集6个月的主要实施结果， 暴露于条件和1年后，以允许（a）活性和预 暴露期和（B）活动期和维持期。结果将指导今后的努力， 枪支安全是一种普遍的自杀预防策略。在目标1中，我们将确定 关于执行结果的执行战略（即，父母报告的临床医生忠诚度，达到（多少 接受干预的家庭）、电缆锁的分布、可接受性和成本）。在目标2中，我们还将测试 可能的实施战略机制（即，它是如何工作的）。在目标3中，我们将检查临床 结果包括父母报告的安全储存行为。该研究可提高火器的实施 安全干预措施，并确定国家执行的最佳方法，最终目标是节省 美国青年的生活，与NIMH目标4保持一致。