Computerized Adaptive Suicidal Risk Stratification and Prediction

摘要 在接下来的60分钟内，美国将至少有57人试图自杀，其中5人将自杀 去死吧。其中超过80%的人在去世前12个月内遇到过医疗保健提供者， 但他们的风险将没有被检测到，或者如果被检测到，量化很差，没有得到充分的监控 纵向的。拟议的研究将通过建立和验证计算机化的 自杀自适应测验--扩展版(CAT-SS扩展版)，可以筛选、量化、 并以一种远远优于现有工具的方式监测自杀风险。它将启用至少三个零键 自杀表现要素，包括系统、标准化的前线自杀风险筛查和 跨护理地点测量(识别)、跟踪和沟通风险(过渡)和监测 持续质量改进活动(改进)导致的患者结果的变化。在一个范例中 在创新方面，CAT-SS扩展后不仅将包括同类中的第一个多维CAT，它 将引入已经由NIMH资助的精神健康中心验证的自杀风险指标 研究网络(MHRN)直接来自卫生系统的电子健康记录(EHR)。此SBIR快速 Track有两个阶段。第一阶段将建立CAT-SS扩展，从建立良好的初步开始 使用迭代用户测试对20个临床医生-患者二元组进行工作和使用，以改进功能。第二阶段将有 两个目标。第一个目标是验证扩展的CAT-SS对照独立研究临床医生的 自杀危险分层和自杀行为指数访问24周后(n=700)。第二个目标是 将经过验证的CAT-SS完全双向集成到UMASS的EHR生产环境中 并将对约30名自杀风险较高的患者进行新样本的临床可用性和可接受性评估。 创新和影响：虽然传统的自杀筛查工具存在，但它们非常有限，结论是 得到了系统审查、全国预防自杀行动联盟和NIMH的支持。因为 在这些限制中，强大的、经过充分验证的临床决策支持指导适当的护理水平并不 存在，强化了非标准化和低效的工作流程，如保守秩序的倾向 不必要的紧急精神评估。扩展的CAT-SS将解决这些众所周知的问题 多维CAT和EHR中体现的使用尖端策略的测量限制 风险指标，这是现有措施无法实现的前所未有的能力。虽然这项研究 以ED为起点，因为其众所周知的风险负担和新兴的文献支持 全民自杀风险筛查的价值结合简单干预，CAT-SS将得到扩展 专门设计并后来进行测试，作为适合企业的第一种自杀风险监控方法 跨环境和护理地点部署，这对自杀预防和 零自杀模型强调整体系统变革的基础。

ABSTRACT In the next 60 minutes, at least 57 people in the United States (US) will attempt to kill themselves, and five will die. Over 80% of these individuals encountered a healthcare provider in the 12 months before his or her death, but their risk will have gone undetected or, if detected, poorly quantified and not sufficiently monitored longitudinally. The proposed research will address this deficit by building and validating the Computerized Adaptive Test for Suicide Scale -- Expanded (CAT-SS EXPANDED), software that can screen for, quantify, and monitor suicide risk in a way far superior to existing instruments. It will enable at least three key Zero Suicide performance elements, including systematic, standardized frontline suicide risk screening and measurement (Identify), tracking and communicating risk across locations of care (Transitions), and monitoring changes in patient outcomes resulting from continuous quality improvement activities (Improve). In a paradigm shifting innovation, the CAT-SS EXPANDED will not only comprise the first multi-dimensional CAT of its kind, it will import suicide risk indicators that have already been validated by the NIMH-funded Mental Health Research Network (MHRN) directly from a health system’s electronic health record (EHR). This SBIR Fast Track has two phases. Phase 1 will build the CAT-SS EXPANDED, starting with well-established preliminary work and using iterative user testing with 20 clinician-patient dyads to refine the features. Phase 2 will have two Aims. The first Aim will validate the CAT-SS EXPANDED against an independent research clinician’s suicide risk stratification and suicidal behavior 24 weeks after the index visit (n=700). The second Aim will complete two-way integration of the validated CAT-SS EXPANDED into UMass’ EHR production environment and will evaluate clinical usability and acceptability with a new sample of ~30 suicide-risk enriched patients. Innovation and Impact: While traditional suicide screening tools exist, they are very limited, a conclusion supported by systematic reviews, the National Action Alliance for Suicide Prevention, and the NIMH. Because of these limitations, strong, well-validated clinical decision support to guide appropriate levels of care do not exist, reinforcing non-standardized and inefficient workflow, such as a tendency to conservatively order unnecessary emergency psychiatric evaluations. The CAT-SS EXPANDED will address these well-known measurement limitations using cutting edge strategies embodied in multi-dimensional CAT and EHR-derived risk indicators, an unprecedented capability impossible to achieve with existing measures. While this study focuses on the ED as a starting point because of its well-known risk burden and emerging literature supporting the value of universal suicide risk screening combined with brief interventions, the CAT-SS EXPANDED will be specifically designed and later tested as the first approach to suicide risk monitoring suitable for enterprise deployment across settings and locations of care, which is transformational for suicide prevention and fundamental to the Zero Suicide model’s emphasis on holistic system change.