RFA-CE-22-004, Optimizing Firearm Suicide Prevention in Healthcare

自杀占美国枪支死亡人数的60%，在阿拉斯加，科罗拉多， 华盛顿。枪支是美国最常见的自杀方式，和枪支的使用权 增加自杀风险。大多数死于自杀的人在自杀前一年看过卫生保健提供者。 因此，临床提供者有重要的机会对有枪支风险的患者进行干预 自杀虽然枪支接触与患者的健康和安全有关，但有关枪支的常规问题 获得的机会是罕见的，而且缺乏证据来指导实施有希望的 预防枪支自杀的临床实践，包括枪支使用评估和提供者， 就限制访问展开对话。我们的团队已经开始在一系列的研究中解决这一证据缺口， 创新研究侧重于枪支获取评估。具体来说，我们确定了成年人 初级保健和心理健康患者将回答有关枪支的标准化问题，并且 强调了将筛查问题限制在接受精神卫生保健的患者身上是如何错过许多有风险的人的 患者我们还引起了患者和临床医生对枪支进入评估的关注，并描述了 他们的建议如何解决有关隐私、自主权和所有权的问题。 这项研究将建立在这些发现和解决的关键需要，以病人为中心的战略， 通过疾病预防控制中心RFA-CE目标之一， 22-004：研究为创新和有前途的火器伤害/死亡率的发展提供信息 预防战略。以人为本的设计与基于社区的前瞻性研究 新的数据收集活动的备选方案B和 预防活动。我们将采用发现、设计和构建以及测试框架， 三个卫生保健系统的实施战略，为社区约130万人提供服务， 枪支拥有率和自杀率高。我们将： 1（发现）：收集患者、临床医生和领导者对临床实践的看法， 并与有枪支自杀风险的个人接触，并确定实践机会 通过回顾性病历审查和病历描述性分析进行改进。 2（设计/构建）：与临床和质量改进人员和领导层合作进行设计 干预策略，以支持预防枪支自杀的循证临床实践。 3（测试）：在三个医疗保健系统中进行试点测试临床干预策略，以证明 可行性、可接受性和可用性;以及衡量覆盖范围。 我们的工作将为未来传播以患者为中心的枪支自杀奠定坚实的基础 预防措施和有效性评估。

Suicide accounts for 60% of U.S. firearm deaths, with even higher rates in Alaska, Colorado, and Washington. Firearms are the most common method of suicide in the U.S., and firearm access is linked to increased suicide risk. Most people who die by suicide see a health care provider in the year prior to death, thus clinical providers have important opportunities to intervene with patients at risk for firearm suicide. Though firearm access is relevant to patients’ health and safety, routine questions about firearm access are uncommon and there is a dearth of evidence available to guide implementation of promising clinical practices for firearm suicide prevention, including firearm access assessment and provider- initiated dialogue about limiting access. Our team has begun to address this evidence gap in a series of innovative studies focused on firearm access assessment. Specifically, we established that adult primary care and mental health patients will answer standardized questions about firearms, and highlighted how limiting screening questions to patients receiving mental health care misses many at risk patients. We also elicited patient and clinician concerns about firearm access assessment and described how concerns about privacy, autonomy, and ownership rights may be addressed by their suggestions. This study will build on these findings and address the critical need for patient-centered strategies to identify and engage patients at high-risk of firearm suicide through Objective One of CDC’s RFA-CE- 22-004: Research to inform the development of innovative and promising firearm injury/mortality prevention strategies. Human Centered Design and Community Based Participatory Research approaches will support Option B for new data collection activities and the implementation of prevention activities. We will employ the Discover, Design and Build, and Test framework to inform implementation strategies in three healthcare systems serving ~1.3 million people in communities with high rates of firearm ownership and suicide. We will: 1 (DISCOVER): Elicit patient, clinician, and leader perspectives on clinical practices for identifying and engaging individuals at risk of firearm suicide, and to identify opportunities for practice improvement via retrospective chart review and descriptive analyses of medical records. 2 (DESIGN/BUILD): Partner with clinical and quality improvement staff and leadership to design intervention strategies to support evidence-based clinical practices for firearm suicide prevention. 3 (TEST): Pilot test clinical intervention strategies in three healthcare systems to demonstrate feasibility, acceptability, and usability; and to measure reach. Our work will lay a strong foundation for future dissemination of patient-centered firearm suicide prevention practices and evaluations of effectiveness.