A System of Safety (SOS): Preventing Suicide through Healthcare System Transformation

项目总结/摘要 意义：尽管医疗机构内基于系统的努力被认为是有前途的， 至于如何有效地预防自杀，我们知之甚少。安全系统（SOS） 代表了一个无与伦比的机会，研究实施最佳实践自杀相关的护理 体现零自杀护理基本要素的流程，包括急诊科、住院部、 医疗和行为健康单位，以及与大型医疗保健系统相关的初级保健诊所。 研究者：项目组在自杀风险筛查、评估、 干预和护理过渡（Boudreaux）;实施科学和保健系统变革（Kiefe）; 工业工程和医疗保健持续质量改进（CQI）（Pelletier）;数据科学（Mathew）; 电子健康记录（EHR）通信（Cutrona）;有效性试验设计和分析（Kiefe; Chang）;和经济分析（Rodriguez-Monguio）。他们受到共同研究者的称赞， 拥有丰富的医疗保健系统运营专业知识的顾问。加起来，这个团队有超过100个 与自杀预防、系统变更和有效性试验设计和分析相关的出版物。 创新：除了率先实施全系统自杀风险识别， 预防工作，SOS将是第一个研究著名的CQI战略称为精益和一个新的 轴辐式部署战略。它将创新医疗服务研究方法， 统计学策略，以分析来自阶梯楔形群随机设计的数据。 方法：本有效性试验将在总共39个临床单位中使用阶梯式楔形设计， 将被随机分配到给定的开始时间。目标1将衡量自杀风险筛查（干预目标）， 筛查对风险识别的影响（患者结局）。目标2将衡量有效执行 临床医生管理的干预，例如具有手段限制咨询的安全规划（干预 目标），自杀，自杀未遂和自杀相关的急性医疗保健（患者结局）。探索性 目的将检查干预的作用机制，调节剂，经济学和人口效应。 环境：随着ED-SAFE和其他相关项目的成功，UMMHC和马萨诸塞大学 医学院已经明确建立了成功开展这项研究的能力。 影响：这项研究的创新方法使其对自杀领域产生了重大影响 预防、CQI和有效性试验设计和分析。没有任何其他群体能够更好地准备回答所有问题， 这份报告中提出的重要研究问题。这些交付成果将在以下方面具有广泛意义： 护理环境、医疗和行为人群以及年龄组。

PROJECT SUMMARY/ABSTRACT Significance: Although system-based efforts within healthcare settings have been heralded as promising for suicide prevention efforts, little is known about how to effectively achieve this. The System of Safety (SOS) represents an unparalleled opportunity to study the implementation of best practice suicide-related care processes that embody the Zero Suicide Essential Elements of Care across emergency departments, inpatient medical and behavioral health units, and primary care clinics associated with a large healthcare system. Investigators: The Project Team has extensive expertise in suicide risk screening, assessment, intervention, and care transition (Boudreaux); implementation science and healthcare systems change (Kiefe); industrial engineering and healthcare continuous quality improvement (CQI) (Pelletier); data science (Mathew); electronic health record (EHR) communication (Cutrona); effectiveness trial design and analysis (Kiefe; Chang); and economic analyses (Rodriguez-Monguio). They are complimented by Co-Investigators and advisors with extensive healthcare systems operations expertise. Combined, the team has over 100 publications related to suicide prevention, systems-change, and effectiveness trial design and analytics. Innovation: In addition to pioneering the implementation of system-wide suicide risk identification and prevention efforts, the SOS will be one of the first to study the prominent CQI strategy called Lean and a novel hub-and-spoke deployment strategy. It will innovate healthcare services research methods by applying novel statistical strategies to analyze data from a stepped wedge cluster randomized design. Approach: This effectiveness trial will use a stepped wedge design across a total of 39 clinical units which will be randomized to a given start time. Aim 1 will measure suicide risk screening (intervention target) and screening's impact on risk identification (patient outcome). Aim 2 will measure the effective implementation of clinician administered interventions, such as safety planning with means restriction counseling (intervention target), on suicide, suicide attempts, and suicide-related acute healthcare (patient outcomes). Exploratory Aims will examine mechanisms of action, moderators, economics, and population effects of the intervention. Environment: With the success of the ED-SAFE and other relevant projects, UMMMHC and UMass Medical School have clearly established their capability of successfully carrying out this study. Impact: This study's innovative approach positions it for a significant impact on the fields of suicide prevention, CQI, and effectiveness trial design and analysis. No other group is better prepared to answer all of the important research questions posed in this proposal. The deliverables will have broad significance across care settings, medical and behavioral populations, and age groups.