Impact of Telehealth on Emergency Department Management of Suicide Risk

项目摘要/摘要 在美国，越来越多的儿童和成年人因自杀意念(SI)和自杀未遂(SA)而到急诊科寻求治疗，自杀是各个年龄段的主要死亡原因。在美国，ED设置已经成为防止自杀的关键干预点。尽管有这种明显的需求，但大多数急救人员缺乏解决自杀风险的资源，迫切需要确定战略，以改善对这一高危和脆弱人群的循证护理。人们越来越感兴趣的是利用技术来解决提供者短缺和护理方面的相关差距。远程心理健康，以下简称“远程健康”，依赖于与远程临床医生举行视频和音频会议以及使用共享的电子健康记录等技术，以改善与心理健康专家的接触。到目前为止，急诊科医生如何使用远程医疗，特别是远程医疗服务如何整合循证实践(EBP)来评估和管理自杀风险较高的患者，人们知之甚少。此外，传播和实施远程保健工作的信息很少。该项目的目标是全面了解儿童和成人使用远程保健的情况，包括它是否增加了获得治疗的机会和改善治疗结果，并收集与未来执行工作有关的信息。利用一项全国性的调查，研究小组将收集关于使用和不使用远程医疗的急诊室自杀预防做法的详细数据。具体地说，我们将对全国600名急诊室进行调查，并检查哪些医院和服务领域的特征与(A)远程医疗服务的存在和(B)远程医疗服务特征(临床医生资质、可用时间、技术、计费和临床医生合同)相关。

Project Summary/Abstract Children and adults in the US are increasingly seeking treatment in Emergency Departments (EDs) for suicide ideation (SI) and suicide attempt (SA), and suicide is a leading cause of death across age groups. The ED setting has become a critical point of intervention to prevent suicide in the US. In spite of this demonstrated need, most EDs lack resources to address suicide risk, and there is an urgent need to identify strategies to improve evidence-based care for this high-risk and vulnerable population. There is increasing interest in the use of technology to address provider shortages and related gaps in care. Tele-mental health, hereafter “telehealth,” relies on technologies including video- and audio-conferencing with remote clinicians and use of shared electronic health records to improve access to mental health specialists. To date, little is known about how EDs use telehealth, and specifically how telehealth services integrate evidence-based practices (EBPs) to evaluate and manage patients at high risk of suicide. Further, there is little information to dissemination and implementation efforts for telehealth. The objectives of this project are to gain a comprehensive picture of telehealth use among children and adults visiting EDs for SI/SA, including whether it increases access to treatment and improves treatment outcomes, and to gather information relevant to future implementation efforts. Using a national survey, the study team will capture detailed data on suicide prevention practices in EDs who do and do not use telehealth. Specifically, we will survey a national sample of 600 EDs and examine which hospital and service area characteristics are associated with (a) presence of telehealth services and (b) telehealth service characteristics (clinician credentials, hours of availability, technologies, billing, and clinician contracts).