Computerized Adaptive Suicidal Risk Stratification and Prediction

摘要 在接下来的60分钟内，美国至少有57人试图自杀，5人将在 死的超过80%的人在他或她去世前的12个月内遇到了医疗保健提供者， 但它们的风险将没有被发现，或者即使被发现，也没有得到充分的量化和监测 纵向。拟议的研究将通过建立和验证计算机化的 自杀量表自适应测试-扩展（CAT-SS扩展），软件可以筛选，量化， 并以一种远优于现有仪器的上级方式监测自杀风险。它将启用至少三个关键的零 自杀表现元素，包括系统化、标准化的前线自杀风险筛查， 测量（识别）、跨护理地点跟踪和沟通风险（过渡），以及监控 持续质量改进活动（Improve）导致的患者结局变化。在一个范例中， 通过不断创新，CAT-SS EXPANDED不仅将包括同类产品中的第一个多维CAT， 将导入已经由NIMH资助的心理健康中心验证的自杀风险指标， 研究网络（MHRN）直接从卫生系统的电子健康记录（EHR）。此SBIR快速 轨道有两个阶段。第一阶段将建立CAT-SS EXPANDED，从完善的初步 工作和使用迭代用户测试与20临床医生-患者的二人组，以完善功能。第二阶段将有 两个目标。第一个目标将根据独立研究临床医生的 自杀风险分层和索引访视后24周的自杀行为（n=700）。第二个目标将 将经过验证的CAT-SS EXPANDED完全双向集成到马萨诸塞大学的EHR生产环境中 并将评估临床可用性和可接受性与一个新的样本约30自杀风险丰富的患者。 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 该研究得到了系统评价、全国预防自杀行动联盟和NIMH的支持。因为 在这些局限性中，强有力的、经过充分验证的临床决策支持，以指导适当的护理水平， 存在，加强非标准化和效率低下的工作流程，如倾向于保守订购 不必要的紧急精神评估CAT SS EXPANDED将解决这些众所周知的 测量的限制，使用尖端战略体现在多维CAT和EHR派生 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 由于其众所周知的风险负担和新兴文献支持， 普遍的自杀风险筛查结合简单干预的价值，CAT-SS扩展将 专门设计，后来被测试为第一种适合企业的自杀风险监测方法 在护理环境和地点进行部署，这对自杀预防和 零自杀模型强调整体系统变革。

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.