Emergency Department Recognition of Mental Disorders and Short-Term Outcome of Deliberate Self-Harm in Older Adults

 预防自杀是美国医疗保健系统面临的重大公共卫生挑战之一。那些因故意自残而在综合医院寻求紧急护理的人，在短期内重复自残和自杀的风险非常高。然而，只有大约一半的患者接受紧急心理健康评估。在出院到社区的自我伤害患者中，只有一半在接下来的一个月内接受后续门诊心理健康护理。拟议的研究将通过测试以下五种紧急服务中的每一种是否会影响住院，及时的门诊心理健康护理，反复自我伤害和自杀的短期风险，为解决故意自我伤害的紧急管理缺陷提供信息：1）自杀风险评估和分诊程序，2）安全计划的常规使用，3）现场出院计划，4）现场或随叫随到的心理健康专家，（5）危机心理健康服务的可获得性。 本研究的具体目的是：（1）确定影响获得这五种紧急精神卫生服务的患者、医院和服务环境特征; 2）确定获得这些紧急精神卫生服务是否会影响住院，增加及时门诊精神卫生后续护理的可能性，并降低故意自残和自杀的短期风险，以及3）定性地了解这些紧急精神卫生服务如何在社区实践中运作。 我们将通过从大约500个急诊室中抽取1万多名私人和医疗补助保险故意自残患者的样本来实现这些目标。在每个治疗医院，我们将调查急诊科主任，以确定五个急诊科服务的存在或不存在。有关急诊部门的其他信息将从全州急诊部门数据库中获得，医院信息将从美国医院协会年度调查中获得，区域精神卫生服务信息将从药物滥用和精神卫生服务管理局调查中获得。反复故意自我伤害将通过行政索赔记录进行评估，自杀将通过将个体患者与国家死亡指数相匹配来确定。然后，我们将使用此患者，急诊科，医院和服务环境信息的倾向评分调整模型的影响，关键的急诊服务住院，后续门诊心理健康护理，早期反复故意自残，自杀。这些问题将通过与选定的紧急部门的主要前线工作人员进行定性访谈，以更详细地研究这些服务如何运作，以及是什么阻碍了他们在社区实践中的实施。这些新信息将指导故意自残的应急管理的改进。

 DESCRIPTION (provided by applicant): Preventing suicide is one of the great public health challenges facing the US health care system. People who seek emergency care in general hospitals for deliberate self-harm are at exceptionally high short-term risk of repeated self-harm and suicide. Yet only about one-half of these patients receive emergency mental health evaluations. Among self-harm patients who are discharged to the community, only one-half receive follow-up outpatient mental health care in the following month. The proposed study will inform efforts to address deficiencies in the emergency management of deliberate self-harm by testing whether access to each of the following five emergency services influences inpatient admission, timely outpatient mental health care, short- term risk of repeated self-harm and suicide: 1) suicide risk assessment and triage procedures, 2) routine use of safety plans, 3) an on-site discharge planner, 4) an on-site or on-call mental health specialist, and 5) availability o crisis mental health services. The specific aims of the study are 1) to identify patient, hospital and service environment characteristics that influence access to these five emergency mental health services; 2) to determine whether access to each of these emergency mental health services influences inpatient admission, increases the likelihood of timely outpatient mental health follow-up care and reduces the short-term risk of deliberate self-harm and suicide, and 3) to understand qualitatively how these emergency mental health services operate in community practice. We will address these aims by extracting a sample of over ten thousand privately and Medicaid insured deliberate self-harm patients from approximately 500 emergency departments. At each of the treating hospitals, we will survey emergency medical directors to determine the presence or absence of the five emergency department services. Additional information about the emergency departments will be available from the Statewide Emergency Department Databases, hospital information will be available from the American Hospital Association Annual Survey, and regional mental health service information will be available from the Substance Abuse and Mental Health Services Administration surveys. Repeated deliberate self-harm will be assessed with administrative claims records and suicide will be determined by matching individual patients to the National Death Index. We will then use this patient, emergency department, hospital, and service environment information in propensity score adjusted models of the effects of the key emergency services on inpatient admission, follow-up outpatient mental health care, early repeated deliberate self-harm, and suicide. These issues will be examined in greater detail through qualitative interviews with key front line staff at selected emergency departments to probe how these services operate and what impedes their implementation in community practice. This new information will guide improvements in the emergency management of deliberate self-harm.