Telehealth to Improve Prevention of Suicide (TIPS) in EDs

摘要 意义：我们的研究将严格评估同步的、就诊期间的远程健康 评估和干预服务可以成功地克服获得行为健康和 急诊科自杀相关护理不合标准，包括评估对系统的影响 指标，RFA-MH-20-226的主要目标。值得注意的是，我们的研究将超过这一基本要求，因为它 将扩大我们对ED-Safe访后电话干预的相对附加值的了解，并 将创造与实施和维持有关的关键因素的知识。 调查人员：该团队在基于医疗系统的自杀预防方面拥有丰富的专业知识 持续质量改进实施战略(Boudreaux、Larkin、Miller)，针对行为的远程健康 健康障碍(Boudreaux、Davis-Martin、Brown、Allen)，使用“大数据”作为结果和干预目标 确定(Mathew，Liu，Li，Clements)和实施科学(Boudreaux，Larkin，Davis-Martin)。 创新：这将是第一项在ED评估远程健康预防自杀的研究。它会用得最好的- 在远程保健和预防自杀方面都有实践，旨在迅速传播。我们的研究 设计是一个中断的时间序列，带有嵌套的RCT和并行的非干预控制EDS，体现了切割 EDGE实施科学方法论。我们的分析是以NIMH的实验疗法为模型的 范式，使我们能够评估适合于医疗服务提供研究的干预目标。 方法：我们将比较两个目前没有现场干预的急诊室的三种情况 行为健康专家：(1)照常治疗(TAU)，(2)远程健康改善自杀预防 (TIPS)，将仅包括访问内远程医疗组件，以及(3)TIPS+EDSAFE，将包括 访问组件内和访问后组件。目标1将评估TIPS是否单独改善了主要系统指标和 与TAU相比，自杀相关的护理做法。AIM 2将比较12个月患者的预后，包括 自杀综合结果，跨越TAU、TIPS和TIPS+EDSAFE。目标3将评估与以下因素相关的因素 执行和可持续性，包括成本。将对两个非干预ED进行监测，以控制 宏观制度变化和长期趋势。现有的大数据来源，通过结构化图表审查进行了扩充， 将被用于有效的结果确定，以最大限度地提高样本代表性。 环境：马萨诸塞州大学通过NIMH资助的成功证明了它支持这项研究的能力 安全系统(SOS)研究，零自杀实用临床试验，以及其成功的远程保健 由美国国立卫生研究院和马萨诸塞州联邦资助的工作。 影响：这些技巧将解决围绕远程健康在自杀中的作用的许多基本问题 在高效、务实的临床试验中进行预防，最大限度地发挥研究的科学和公共卫生影响 建立一个单独的数据库，作为自杀预防社区的持久资源。

ABSTRACT Significance: Our study will rigorously evaluate whether synchronous, within-visit telemental health evaluation and intervention services can successfully overcome poor access to behavioral health and substandard suicide-related care in emergency departments (EDs), including evaluating the impact on system metrics, a primary goal of RFA-MH-20-226. Notably, our study will surpass this primary requirement, because it will extend our understanding of the relative added value of the ED-SAFE post-visit telephone intervention and will create knowledge about key factors related to implementation and sustainment. Investigators: The team has extensive expertise in healthcare systems-based suicide prevention using continuous quality improvement implementation strategies (Boudreaux, Larkin, Miller), telehealth for behavioral health disorders (Boudreaux, Davis-Martin, Brown, Allen), using “big data” for outcome and intervention target ascertainment (Mathew, Liu, Li, Clements), and implementation science (Boudreaux, Larkin, Davis-Martin). Innovation: This will be the first study to evaluate telehealth for suicide prevention in the ED. It will use best- practices in both telemental health and suicide prevention and is designed for rapid dissemination. Our study design, an interrupted time series with a nested RCT and parallel Non-intervention control EDs, embodies cutting edge implementation science methodology. Our analyses are modeled after NIMH's experimental therapeutics paradigm, allowing us to evaluate intervention targets appropriate for healthcare service delivery studies. Approach: We will compare three conditions across two Intervention EDs that currently do not have on-site behavioral health specialists: (1) Treatment as usual (TAU), (2) Telehealth to Improve Prevention of Suicide (TIPS), which will include within-visit telehealth components only, and (3) TIPS+EDSAFE, which will include within- and post-visit components. Aim 1 will evaluate whether TIPS alone improves primary system metrics and suicide-related care practices compared to TAU. Aim 2 will compare 12-month patient outcomes, including a suicide composite outcome, across TAU, TIPS, and TIPS+EDSAFE. Aim 3 will evaluate factors related to implementation and sustainability, including costs. Two Non-intervention EDs will be monitored to control for macro system changes and secular trends. Existing big data sources, augmented by structured chart review, will be leveraged for efficient outcome ascertainment that maximizes sample representativeness. Environment: UMass has demonstrated its ability to support this study by its success with the NIMH-funded System of Safety (SOS) study, a Zero Suicide pragmatic clinical trial, in addition to its successful telehealth efforts funded through NIH and the Commonwealth of Massachusetts. Impact: The TIPS will address numerous fundamental questions around the role of telehealth in suicide prevention in a highly efficient, pragmatic clinical trial, maximizing the study's scientific and public health impact and building a singular database that will serve as an enduring resource to the suicide prevention community.