Effectiveness and Implementation of eScreening in Post 9/11 Transition Programs

9/11 后过渡计划中电子筛选的有效性和实施

• 批准号: 10065205
• 负责人: James Pittman
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10065205
• 关键词: Address; Adoption; Alcohols; Area; Caring; Case Manager; Clinical; Computer software; Data; Depressive disorder; Detection; Diagnosis; Diffusion; Documentation; Early Diagnosis; Early identification; Educational workshop; Effectiveness; Enrollment; Evaluation; Evidence based practice; Feedback; Feeling suicidal; Goals; Gold; Health; Health system; Healthcare; Hybrids; Intervention; Interview; Lead; Maintenance; Manuals; Medical Records; Mental Depression; Mental Health; Mental disorders; Methodology; Methods; Modeling; Names; Online Systems; Outcome; Paper; Patients; Performance; Phase; Pilot Projects; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Process; Questionnaires; Randomized; Reporting; Research; Risk; Site; Speed; Suicide; Suicide prevention; Symptoms; System; Technology; Testing; Time; Training; Training Support; Veterans; Work; alcohol use disorder; base; clinical care; comparative; cost; design; effective therapy; effectiveness evaluation; effectiveness research; implementation research; implementation science; implementation strategy; improved; innovation; post intervention; pragmatic trial; programs; research to practice; response; scale up; screening; screening program; suicidal behavior; suicidal risk; suicide rate; user centered design; web-based assessment

Background: Veterans disproportionately account for to 22% of all known suicides in the US. Screening for suicide risk at the first contact with an organization is a best practice in the national Zero Suicide framework and vital to enhancing access to appropriate care. Transition Care Management (TCM) programs are positioned to screen post-9/11 Veterans at the critical moment of enrollment in healthcare. Unfortunately, many Veterans who present for the first time in VHA with recent suicidal thoughts do not receive same day suicide risk evaluation (SRE), partly due to cumbersome screening processes. eScreening is a web-based Gold Standard Promising Practice electronic screening system with real-time scoring and integration into CPRS/VistA. Our eScreening effectiveness pilot in 1,372 post-9/11 Veterans and our 2-site multicomponent implementation strategy (MCIS) pilot showed increase speed and rate of SRE and sustainment of eScreening in two pilot sites. More research is warranted to test both. Significance/Impact: This proposal responds to HSR&D Priority Areas of: Suicide prevention, Increasing the real-world impact of research, and Implementation science. Our data will inform best practices in suicide prevention through early identification. This project will also allow for real-world integration of research into practice and inform implementation efforts for technology. Innovation: eScreening is a unique program developed with feedback from Veterans. To our knowledge, this is the first study to integrate VHA developed mobile patient-report screening technology to improve screening in TCM programs. It is also the first to examine the impact of electronic screening on rates of suicide risk evaluation and referral to care. Specific Aims: Aim 1. Evaluate the effectiveness of eScreening, compared to paper and verbal screening, on rate and speed of screening completion (suicide screening & evaluation, PTSD, depression, alcohol) and referral to mental health care in 8 TCM programs, guided by the RE-AIM outcomes of PRISM. Aim 2: Evaluate the feasibility, acceptability, and potential impact of the MCIS, guided by the RE-AIM outcomes of PRISM, adoption, implementation, and maintenance using mixed methods. We will also document and calculate replication costs across sites. Aim 3. Describe and compare high and low eScreening reach sites guided by contextual constructs of PRISM using qualitative comparative analysis to explore factors influencing the reach of eScreening and the use of the eScreening MCIS. Methodology: We propose an 8 site 4-year, stepped-wedge, mixed-method, Hybrid Type 2, pragmatic trial to compare eScreening to screening as usual while evaluating potential impact of the MCIS in TMC programs. Aim 1 outcomes will be collected via deidentified chart pull at the start and end of the pre-implementation phase, the 9-month intervention period, and 9-months post intervention. Aim 2 outcomes will be collected quantitatively from TCM staff questionnaires and qualitatively from interviews. Aim 3 data will be collected at the same intervals as Aim 2. Next Steps/Implementation: We will use the findings of this research to inform suicide prevention early identification best practices and enterprise scale-up of eScreening with our VACO partners.

背景：在美国所有已知的自杀事件中，退伍军人占比高达22%。筛选 在国家零自杀框架中，第一次接触一个组织的自杀风险是一种最佳做法 这对于增加获得适当护理的机会至关重要。过渡期护理管理(Medics)计划包括 定位于在医疗保健注册的关键时刻筛选9/11事件后的退伍军人。不幸的是，许多人 首次出现自杀念头的退伍军人不会在同一天自杀 风险评估(SRE)，部分原因是筛选过程繁琐。EScreening是基于Web的黄金 具有实时评分和集成的标准前景实践电子筛选系统 CPRS/Vista。我们在1,372名9/11后退伍军人中进行的电子筛查有效性试验和我们的两个站点多组件 实施战略(MCIS)试点显示SRE的速度和比率有所提高，并保持了eScreen 在两个试点地点。需要更多的研究来检验这两种情况。意义/影响：本提案回应 HSR&D的优先领域：自杀预防、增加研究和实施的现实影响 科学。我们的数据将为通过早期识别预防自杀的最佳做法提供信息。这个项目将 还允许在现实世界中将研究与实践相结合，并为技术实施工作提供信息。 创新：eScreening是一个独特的程序，它是根据退伍军人的反馈开发的。据我们所知，这 是第一项整合VHA开发的移动患者报告筛查技术以改进筛查的研究 在中医课程中。它也是第一个研究电子筛查对自杀风险的影响。 评估和转介到护理中心。具体目标：目标1.评估eScreen的有效性，与 纸质和口头筛查，关于筛查完成率和速度(自杀筛查和评估， 在RE-AIM的指导下，8个中医项目中的创伤后应激障碍、抑郁、酒精)和转诊至精神卫生保健 PRISM的结果。目标2：在指导下，评估社区卫生信息系统的可行性、可接受性和潜在影响 使用混合方法的PRISM、采用、实施和维护的RE-AIM结果。我们会 还可以记录和计算跨站点的复制成本。目标3.描述和比较高和低 使用定性比较分析对PRISM的上下文结构指导的REACH站点进行电子筛选 探讨影响电子筛查可及范围的因素和电子筛查MCIS的使用情况。方法论：我们 提出了一项为期4年的8个站点、阶梯式、混合方法、混合类型2的实用试验，以进行比较 电子筛查到正常筛查，同时评估MCIS在TMC项目中的潜在影响。目标1 在实施前阶段的开始和结束时，将通过确定的图表拉动来收集结果 干预期为9个月，干预后为9个月。目标2的结果将被量化地收集 来自中医人员的问卷调查和定性的访谈。目标3的数据将在同一时间收集 间隔时间作为目标2.下一步/实施：我们将使用这项研究的结果来告知自杀 与我们的VACO合作伙伴一起预防、及早识别eScreening的最佳实践和企业规模。