Emergency Department Recognition of Mental Disorders and Short-Term Outcome of Deliberate Self-Harm in Older Adults
急诊科对老年人精神障碍和故意自残的短期结果的认识
基本信息
- 批准号:9443725
- 负责人:
- 金额:$ 17.11万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2016
- 资助国家:美国
- 起止时间:2016-05-01 至 2021-03-31
- 项目状态:已结题
- 来源:
- 关键词:Accident and Emergency departmentAddressAdmission activityAdultAmerican Hospital AssociationCaringCessation of lifeCharacteristicsCommunitiesCommunity PracticeCommunity of PracticeConsensusData CollectionData SetDatabasesDevelopmentEffectivenessElderlyEmergency CareEmergency MedicineEmergency SituationEmergency medical serviceEnvironmentEpidemiologyEthnographyEvaluationEventGeneral HospitalsGoalsHealth Care CostsHealth PolicyHealth Services AccessibilityHealthcareHealthcare SystemsHospitalsIndividualInformation ServicesInjuryInpatientsInterventionInterviewKnowledgeLongitudinal cohort studyMedicaidMedicalMedical emergencyMental HealthMental Health ServicesMental disordersMethodsModelingOutcomeOutpatientsPatient riskPatient-Focused OutcomesPatientsPerformancePhysician ExecutivesPopulation HeterogeneityProbabilityProceduresPsychiatryPublic HealthQuality IndicatorRecordsResearchResearch MethodologyRiskRisk AssessmentRoleSafetySamplingSelf-Injurious BehaviorServicesSiteSpecialistSuicideSuicide preventionSurveysTestingTimeTriageUnited StatesUnited States Substance Abuse and Mental Health Services AdministrationVariantWorkYouthcohortfollow-uphealth care service utilizationhigh riskimprovedindexingindividual patientinnovationinsightmultidisciplinaryoperationpopulation basedpublic health relevancestatisticssuicidal risk
项目摘要
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.
描述(由申请人提供):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。因故意自残而在综合医院寻求紧急护理的人短期内反复自残和自杀的风险极高。然而,这些患者中只有大约一半接受了紧急心理健康评估。在出院到社区的自残患者中,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的获得是否会影响住院、及时门诊心理保健、反复自残和自杀的短期风险,为解决故意自残应急管理方面的缺陷提供信息:1)自杀风险评估和分诊程序,2)安全计划的常规使用,3)现场出院计划员,4)现场或值班心理健康 专家,以及 5) 危机心理健康服务的可用性。 该研究的具体目的是 1) 确定影响获得这五种紧急心理健康服务的患者、医院和服务环境特征; 2) 确定获得这些紧急心理健康服务是否会影响患者入院、增加及时门诊心理健康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) 定性了解这些紧急心理健康服务在社区实践中的运作方式。 我们将通过从大约 500 个急诊室抽取一万名私人和医疗补助保险的故意自残患者样本来实现这些目标。在每家治疗医院,我们将调查急诊医疗主任,以确定是否提供五项急诊科服务。有关急诊科的更多信息将从全州急诊科数据库中获取,医院信息将从美国医院协会年度调查中获取,区域心理健康服务信息将从药物滥用和心理健康服务管理局调查中获取。将根据行政索赔记录对反复故意自残进行评估,并将通过将个体患者与国家死亡指数相匹配来确定自杀行为。然后,我们将在倾向评分调整模型中使用该患者、急诊科、医院和服务环境信息,以了解关键急诊服务对住院患者、后续门诊心理健康护理、早期反复故意自残和自杀的影响。将通过对选定的急诊部门的主要一线工作人员进行定性访谈来更详细地研究这些问题,以探讨这些服务的运作方式以及阻碍其在社区实践中实施的因素。这些新信息将指导改进故意自残的应急管理。
项目成果
期刊论文数量(0)
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STEVEN C MARCUS其他文献
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{{ truncateString('STEVEN C MARCUS', 18)}}的其他基金
Administrative Data Transfer Masking, Access, and Ethics Core
管理数据传输屏蔽、访问和道德核心
- 批准号:
10774554 - 财政年份:2023
- 资助金额:
$ 17.11万 - 项目类别:
Development and clinical interpretation of machine learning emergency department suicide prediction algorithms using electronic health records and claims
使用电子健康记录和索赔的机器学习急诊科自杀预测算法的开发和临床解释
- 批准号:
10277514 - 财政年份:2021
- 资助金额:
$ 17.11万 - 项目类别:
Development and clinical interpretation of machine learning emergency department suicide prediction algorithms using electronic health records and claims
使用电子健康记录和索赔的机器学习急诊科自杀预测算法的开发和临床解释
- 批准号:
10462646 - 财政年份:2021
- 资助金额:
$ 17.11万 - 项目类别:
Development and clinical interpretation of machine learning emergency department suicide prediction algorithms using electronic health records and claims
使用电子健康记录和索赔的机器学习急诊科自杀预测算法的开发和临床解释
- 批准号:
10631239 - 财政年份:2021
- 资助金额:
$ 17.11万 - 项目类别:
Development and clinical interpretation of machine learning emergency department suicide prediction algorithms using electronic health records and claims
使用电子健康记录和索赔的机器学习急诊科自杀预测算法的开发和临床解释
- 批准号:
10809977 - 财政年份:2021
- 资助金额:
$ 17.11万 - 项目类别:
Improving the Emergency Department Management of Deliberate Self-Harm
完善急诊科对故意自残的管理
- 批准号:
9512435 - 财政年份:2017
- 资助金额:
$ 17.11万 - 项目类别:
Improving the Emergency Department Management of Deliberate Self-Harm
完善急诊科对故意自残的管理
- 批准号:
9265516 - 财政年份:2016
- 资助金额:
$ 17.11万 - 项目类别:
Improving the Emergency Department Management of Deliberate Self-Harm
完善急诊科对故意自残的管理
- 批准号:
9904783 - 财政年份:2016
- 资助金额:
$ 17.11万 - 项目类别:
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