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

背景：退伍军人不成比例地占美国所有已知自杀事件的22%。筛查 在第一次与组织接触时就有自杀风险是国家零自杀框架中的最佳做法 这对加强获得适当护理至关重要。过渡期护理管理（TCM）计划 定位于筛选后9/11退伍军人在关键时刻登记在医疗保健。不幸的是很多 首次出现在VHA的最近有自杀想法的退伍军人不会在同一天自杀 风险评估（SRE），部分原因是繁琐的筛选过程。eScreening是一个基于网络的黄金 Standard Promising Practice电子筛选系统，具有实时评分和集成功能， CPRS/VistA.我们在1，372名9/11后退伍军人中进行了电子筛查有效性试点， 实施战略（MCIS）试点表明，SRE速度和比率有所提高，电子筛查得以维持 两个试点。需要更多的研究来测试这两种情况。意义/影响：该提案响应了 HSR&D优先领域：自杀预防，增加研究的现实世界影响，以及实施 科学我们的数据将通过早期识别为预防自杀提供最佳实践。该项目将 还允许将研究融入实践，并为技术的实施工作提供信息。 创新：eScreening是根据退伍军人的反馈开发的独特计划。据我们所知，这 是第一个研究整合VHA开发的移动的患者报告筛查技术，以改善筛查 中医项目。这也是第一次研究电子筛查对自杀风险率的影响 评估和转介护理。具体目标：目标1。评估eScreening的有效性， 书面和口头筛查，关于筛查完成率和速度（自杀筛查和评估， 创伤后应激障碍，抑郁症，酒精）和转诊到精神卫生保健的8个中医项目，由RE-AIM指导 棱镜的结果。目标2：评估MCIS的可行性、可接受性和潜在影响， PRISM的RE-AIM成果，采用、实施和使用混合方法的维护。我们将 还记录和计算跨站点的复制成本。目标3.描述和比较高和低 通过PRISM的上下文结构指导，使用定性比较分析进行eScreening， 探索影响电子筛查覆盖范围和电子筛查MCIS使用的因素。方法论：我们 建议进行一项8个地点的4年、阶梯楔形、混合方法、混合2型、实用性试验，以进行比较 eScreening到常规筛查，同时评估MCIS在TMC项目中的潜在影响。要求1 在实施前阶段的开始和结束时， 9-干预期9个月，干预后9个月。将定量收集目标2结局 从中医工作人员的问卷调查和定性访谈。目标3数据将在同一时间收集 目标2的间隔下一步/实施：我们将利用这项研究的结果来告知自杀 预防、早期识别、最佳实践以及与我们的VACO合作伙伴一起扩大电子筛查的企业规模。

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.