Evaluation of the Caring Letters Suicide Prevention Intervention after Removal of an Electronic Health Record Flag for Suicide Risk: An Effectiveness-Implementation Hybrid Type 2 Trial

移除电子健康记录自杀风险标记后关怀信自杀预防干预的评估:有效性-实施混合 2 型试验

基本信息

  • 批准号:
    10753299
  • 负责人:
  • 金额:
    --
  • 依托单位:
  • 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:
    2023-04-01 至 2026-03-31
  • 项目状态:
    未结题

项目摘要

ABSTRACT In the electronic health record (EHR), the Veterans Health Administration (VHA) uses patient record flags during periods of high acute risk for suicide (e.g., following a suicide attempt) to alert clinicians and improve suicide prevention services. Unfortunately, recent analyses revealed that after these high-risk flags (HRFs) are discontinued based on clinical judgement, suicide rates remain high in the year that follows. This creates a suicide prevention challenge. To address this need, VHA facilities were required in 2020 to start implementing the Caring Letters suicide prevention intervention for this population. In the Caring Letters intervention, a series of messages are sent to individuals to communicate that they are not forgotten, and that people care about them and are concerned for their well-being. The messages also serve as a reminder that help is available. Multiple randomized clinical trials support the efficacy of Caring Letters for reducing suicide behaviors in acute care settings. The Joint Commission recently promoted Caring Letters, and the intervention is included in the VA/DoD suicide prevention Clinical Practice Guideline for acute care settings. Unfortunately, the mandate to use this intervention with Veterans with a discontinued HRF (VD-HRF) has faced many challenges. Less than half the facilities across the nation have implemented the program. For facilities that have implemented the program, several concerning fidelity problems have been identified, indicating that thousands of Veterans in those catchment areas are not receiving the intervention as intended. Therefore, we propose a partnered program evaluation between the VHA Suicide Prevention Program (SPP), and the proposed evaluation team to examine a new version of the intervention for this unique population. Specifically, the evaluation will randomize all VA facilities to either: (1) Centralized Caring Letters where all the work of administering Caring Letters is centralized with a single, national team (promoting high fidelity and compliance with the requirement), or (2) De-Centralized Caring Letters in which VA facilities continue their local procedures as usual during a 6- month delay before starting Centralized Caring Letters. We will conduct an effectiveness-implementation Hybrid Type 2 trial. As a Hybrid Type 2 trial, the study has dual primary goals. The first is to test the effectiveness of a Caring Letter campaign for VD-HRFs, a relatively new population for the intervention. The second goal is to evaluate the impact of adding an implementation strategy – centralizing the work of Caring Letters – to the existing strategy of mandating change. The evaluation will test two aims. In Aim 1, we will evaluate the effects of Caring Letters on clinical outcomes and VA clinical utilization rates. An exploratory aim will also examine rates of suicide attempts, all-cause mortality, and suicide for Veterans who receive Centralized Caring Letters compared to a historical cohort who received no Caring Letters. In Aim 2, we will evaluate the impact of adding the implementation strategy of centralizing the work of the intervention to the existing implementation strategy of mandating change. Using qualitative interviews, we will evaluate leadership, staff, and provider perspectives on the implementation and sustainability of Centralized Caring Letters. This will be one of the largest evaluations of a Caring Letters intervention ever conducted, and it will provide direct and actionable data to leadership to evaluate the impacts of this major prevention program.
摘要 在电子健康记录(EHR)中,退伍军人健康管理局(VHA)使用患者记录标志 在自杀的高急性风险期间(例如,自杀未遂后),以提醒临床医生和改善 自杀预防服务。不幸的是,最近的分析显示,在这些高风险标志(HRF)之后, 根据临床判断,自杀率在随后的一年仍然很高。这将创建一个 自杀预防挑战为了满足这一需求,VHA设施需要在2020年开始实施 对这一人群的关爱信自杀预防干预。在关怀信干预中,一系列 的信息被发送给个人,传达他们没有被遗忘,人们关心 关心他们,关心他们的幸福。这些消息还可以提醒您可以获得帮助。 多项随机临床试验支持关怀信在减少急性脑梗死患者自杀行为方面的疗效。 护理设置。联合委员会最近推广了“关怀信”,干预措施被纳入了 VA/DoD自杀预防急性护理环境临床实践指南。不幸的是, 使用这种干预与退伍军人中断HRF(VD-HRF)面临着许多挑战。小于 全国有一半的机构已经实施了该计划。对于已实施 计划,几个有关的保真度问题已经确定,表明成千上万的退伍军人在 这些集水区没有得到预期的干预。因此,我们提出了一个合作伙伴, VHA自杀预防计划(SPP)和拟议的评估小组之间的计划评估, 研究针对这一特殊人群的新的干预措施。具体而言,评价将 将所有退伍军人事务部设施随机分配给:(1)集中式关怀信, 信件由一个单一的国家小组集中处理(促进高度忠实和遵守要求), 或(2)非集中式关怀信,其中VA设施在6- 在开始集中关怀信之前延迟了一个月。我们将进行有效的实施 混合型2试验。作为混合2型试验,该研究具有双重主要目标。第一个是测试 针对自愿残疾人基金会的关爱信运动的有效性,这是一个相对较新的干预人群。的 第二个目标是评估增加一项实施战略-集中“关心”工作-的影响 信-对现有的战略授权的变化。评价将检验两个目标。在目标1中,我们 评估关爱信对临床结局和VA临床利用率的影响。探索性的目标 还将研究自杀企图率,全因死亡率,以及接受过自杀治疗的退伍军人的自杀率。 集中式关怀信与未收到关怀信的历史队列进行比较。在目标2中,我们将 评估在《行动计划》中增加集中干预工作的执行战略的影响, 现有的强制性变革执行战略。使用定性访谈,我们将评估 领导层、员工和供应商对集中式关怀的实施和可持续性的看法 字母这将是有史以来最大的一次评估关怀信干预,它将 向领导层提供直接和可操作的数据,以评估这一重大预防方案的影响。

项目成果

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Mark A. Reger其他文献

Mark A. Reger的其他文献

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{{ truncateString('Mark A. Reger', 18)}}的其他基金

Randomized Evaluation of a Caring Letters Suicide Prevention Campaign for Service Members Transitioning to Civilian Life
针对军人过渡到平民生活的关怀信预防自杀运动的随机评估
  • 批准号:
    10181059
  • 财政年份:
    2019
  • 资助金额:
    --
  • 项目类别:
Randomized Evaluation of a Caring Letters Suicide Prevention Campaign for Service Members Transitioning to Civilian Life
针对军人过渡到平民生活的关怀信预防自杀运动的随机评估
  • 批准号:
    9718807
  • 财政年份:
    2019
  • 资助金额:
    --
  • 项目类别:
Randomized Evaluation of a Caring Letters Suicide Prevention Campaign for Service Members Transitioning to Civilian Life
针对军人过渡到平民生活的关怀信预防自杀运动的随机评估
  • 批准号:
    10308564
  • 财政年份:
    2019
  • 资助金额:
    --
  • 项目类别:

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