Evaluating the Impact of Changes in Opioid Prescribing Across Health Systems Implementing Zero Suicide

这一及时的补充将支持我们当前奖项的目标：对国家零利率的评估 跨学习医疗系统的自杀模型(U01MH114087)利用自然实验， 他们计划在全国范围内推出五个行为健康部门的安全规划模板 Kaiser Permanente Regions和Henry Ford Health System在2019年。强烈建议进行安全规划 在零自杀(ZS)框架内的实践，但对个人的有效性知之甚少 可构成安全计划的要素，如致命手段评估、支持性识别 接触、应对技能、警告信号和分心来源。目前的零自杀奖建议 使用阶梯楔形中断时间检查安全规划和致命手段评估的影响- 系列(ITS)方法，将每个变量作为一个二元变量进行衡量(例如，是否进行了安全规划)。智能交通运输系统 方法要求一些站点实施安全规划(安全规划干预站点)，而 其他人则不这样做(为了安全规划而控制现场)。拟议的智能交通运输系统方法现在是有问题的，如果没有进一步的 工作有两个原因：1)所有Kaiser Permanente站点和Henry Ford都决定统一实施 几乎在同一时间进行安全规划，因此没有控制点2)没有控制点，指标 能够准确衡量安全规划/致命手段评估中的基线差异，然后 此后的纵向评估将使我们能够进行评估，但所有文件都是以文本形式存在的- 以临床叙述为基础。在与我们的卫生系统合作开发零自杀指标方面， 我们被告知，基线的安全规划和致命手段评估率不是零， 但实际的增长率尚不清楚。本补充资料将支持使用Natural开发新指标 语言处理来确定基线比率，从中我们可以量化安全规划中的变化 以及在实施新的安全规划模板后的纵向致命手段评估实践 利用我们的零自杀大奖。此外，我们建议利用新实施的 解决安全规划对自杀结果的影响的重要中介的模板， 对新模板的忠诚度，我们将其定义为质量、完整性和与持续的集成级别 关心。我们为这项补充工作提出了以下三个具体目标：1)确定安全的关键术语 计划和致命手段评估1。)开发自然语言处理(NLP)指标以评估 三个零自杀地点发生的安全规划和致死手段评估2)实施NLP 询问安全规划和致命手段评估的识别并测量基线比率3) 实施医疗记录中的电子安全计划模板，制定和实施衡量标准 使用NLP评估安全规划模板的保真度(完整性、质量、完整性和细致性)。

This timely supplement would support our goals for the current award: An Evaluation of the National Zero Suicide Model Across Learning Healthcare Systems (U01MH114087) by capitalizing on a natural experiment, the planned the national roll-out of safety planning templates in behavioral health departments across five Kaiser Permanente regions and Henry Ford Health System in 2019. Safety planning is a highly recommended practice within the Zero Suicide (ZS) framework, but little is known about the effectiveness of the individual elements that can make up a safety plan, such as lethal means assessment, identification of supportive contacts, coping skills, warning signs, and sources of distraction. The current Zero Suicide award proposes to examine the impact of safety planning and lethal means assessment using a stepped-wedged interrupted time- series (ITS) approach, measuring each as a binary variable (e.g. safety planning did or did not occur). The ITS approach requires that some sites implement safety planning (intervention sites for safety planning), while others do not (control sites for safety planning). The proposed ITS approach is now problematic without further work for two reasons: 1) All Kaiser Permanente sites and Henry Ford have decided to uniformly implement safety planning around the same time, therefore there are no control sites 2) Without control sites, metrics that can accurately measure variation in safety planning/lethal means assessment at baseline and then longitudinally thereafter would enable our evaluation to take place, but all of the documentation lives in text- based clinical narratives. In working with our health system leads on the development of Zero Suicide metrics, we have been informed that the rate for safety planning and lethal means assessment at baseline is not zero, but the actual rate is unknown. This supplement will support development of new metrics using Natural Language Processing to determine baseline rates, from which, we can quantify the change in safety planning and lethal means assessment practice longitudinally after implementation of new safety planning templates using our Zero Suicide main award. Furthermore, we propose to take advantage of the newly implemented templates to address an important mediator of the effect of safety planning on suicide outcomes, the impact of fidelity to the new templates, which we define as quality, completeness, and level of integration with ongoing care. We propose the following three specific aims for this supplemental work: 1) Identify key terms for safety planning and lethal means assessment 1.) Develop Natural Language Processing (NLP) metrics to assess the occurrence of safety planning and lethal means assessment at three Zero Suicide sites 2) Implement NLP queries for identification of safety planning and lethal means assessment and measure baseline rates 3) Upon implementation of electronic safety planning templates in medical records, develop and implement metrics using NLP for assessing fidelity (completeness, quality, integration with care) to safety planning templates.