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Aeschi Model in Integrated Care: Treatment Development Study to Improve Outcomes for Suicidal Patients

综合护理中的阿埃斯基模型：改善自杀患者预后的治疗开发研究

基本信息

批准号：
10575211
负责人：
KATHERINE ANNE COMTOIS
金额：
$ 19.17万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-02-17 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10575211
关键词：
Adolescent and Young Adult Adoption Bipolar Disorder Caring Clinical Cognitive Therapy Coping Skills Crisis Intervention Diabetes Mellitus Dialectical behavior therapy Emotions Family Family member Feeling Feeling hopeless Feeling suicidal Health Personnel Hearing Heart Diseases Inpatients Intervention Malignant Neoplasms Medication Management Mental Health Services Methods Modeling Needs Assessment Outcome Pathway interactions Patient Care Patients Prevention Research Primary Care Provider Psychiatry Psychotherapy Recording of previous events Research Risk Assessment Risk Factors Risk Management Self Efficacy Self-Injurious Behavior Series Suicide Suicide attempt Suicide prevention Support System Switzerland Testing Therapeutic Universities Videotape Washington acceptability and feasibility addiction behavioral health collaborative care coping cost effectiveness demographics design evidence base follow-up human centered design improved improved outcome integrated care intervention program medical specialties member mortality pilot test primary care clinic primary care setting psychologic reducing suicide response screening social suicidal suicidal adolescent suicidal individual suicidal patient suicidal risk suicide rate symposium therapy development therapy outcome treatment as usual usability

项目摘要

The suicide rate has increased 28% over the past two decades while heart disease, diabetes, and cancer mortality has declined. Starting in 2011, new standards have led to improved adoption and reach of suicide risk surveillance in primary and specialty care. Treatment, however, has lagged. Collaborative Care (CoCM) in primary care settings has demonstrated small but significant reductions in suicidal ideation when a recognized psychological treatment model is included but not when Collaborative Care only includes medication management, suggesting that improvements to psychological treatments in Collaborative Care could further improve suicide outcomes. Developed in a series of conferences in Aeschi Switzerland, the “Aeschi Model” based on the clinical narrative has become an established approach to suicide care endorsed by leaders across the suicidology field – including the developers of major evidence-based suicide interventions. With support from the Methods Core, this Exploratory (R34) study of the University of Washington Practice-Based Suicide Prevention Research Center will co-design and pilot test the Aeschi Model in Collaborative Care (AM-CoCM) to intervene at the treatment and follow-up steps on the suicide care pathway with adolescent and young adult patients in Collaborative Care who do not require immediate crisis intervention. This study will focus on increasing therapeutic alliance – a key proposed mechanism of the Aeschi approach and the Center. The aims of AM-CoCM are to partner with the University of Washington Primary Care clinics to (1) Co-design Aeschi and Collaborative Care intervention components into AM-CoCM with health care providers, adolescents and young adults with a history of suicidality, and family members of suicidal patients through human centered design; (2) Conduct iterative treatment development of AM-CoCM to test and refine usability, and then (3) Conduct a pilot test of the AM-CoCM intervention components compared to treatment as usual in six primary care clinics to determine (a) usability and acceptability of the intervention components to patients and providers and (b) the components' potential impact on therapeutic alliance and patient and provider self-efficacy, and (c) potential impact on suicidal outcomes. Given the strong theoretical basis for AM-CoCM, this proposal has the potential to develop a high impact intervention for the treatment and follow-up steps of the suicide care pathway in Collaborative Care that will reduce suicide risk and improves therapeutic alliance – potentially without any increase in the quantity of care.

在过去的二十年里，自杀率上升了28%，而心脏病、糖尿病和癌症死亡率已经下降。从2011年开始，新的标准提高了自杀风险的采用率和覆盖面初级和专科护理中的监测。然而，治疗一直滞后。中的协作关怀(CoCM) 初级保健环境显示，当认识到自杀意念时，自杀意念略有减少，但显著减少包括心理治疗模式，但当协作护理仅包括药物时不包括管理，表明合作护理中心理治疗的改善可能会进一步改善自杀结果。在瑞士埃斯基举行的一系列会议上发展起来的“埃斯基模式” 基于临床的叙述已经成为各国领导人认可的自杀护理的既定方法自杀学领域--包括主要循证自杀干预措施的开发者。在来自方法核心，这是华盛顿大学基于实践的自杀的探索性研究(R34) 预防研究中心将共同设计和试点测试协作护理中的Aeschi模型(AM-CoCM)，以对青春期和青壮年自杀护理路径的治疗和随访步骤进行干预不需要立即进行危机干预的协作护理中的患者。这项研究将集中在增加治疗联盟-Aeschi方法和中心提出的一个关键机制。的目标是 AM-CoCM将与华盛顿大学初级保健诊所合作(1)共同设计Aeschi和与医疗保健提供者、青少年和年轻人一起将协作护理干预组件纳入AM-CoCM (2)有自杀史的成年人、有自杀倾向患者的家属；进行AM-CoCM的迭代处理开发，以测试和细化可用性，然后(3)进行试点在六家初级保健诊所测试AM-CoCM干预组件与常规治疗的比较确定(A)患者和提供者对干预组件的可用性和可接受性，以及(B) 各组成部分对治疗联盟以及患者和提供者自我效能的潜在影响，以及(C)潜在影响对自杀结果的影响。鉴于AM-CoCM的强大理论基础，该提议有可能为自杀护理路径的治疗和后续步骤制定高影响力的干预措施协作式护理将降低自杀风险并改善治疗联盟--可能没有任何增加护理的数量。