Examining Intensive Outpatient Programs as a Potential Mechanism to Reduce Suicide Risk During the Post-Hospitalization Period Among Medicaid Recipients

摘要 自杀是美国十大死亡原因之一，自杀率在#年急剧上升 近几十年来。最近的一项荟萃分析表明，精神病患者出院后的自杀率 这一数字为每100,000人年2,078人(一般人口为14.0)。大约一个- 四分之一的自杀死亡发生在精神病院出院后3个月内，这使得这一时期 具有极高的风险。 随着20世纪90年代管理型医疗的到来以及随之而来的医院长度的缩短 建立了住院、强化门诊计划/部分住院计划(IOP/PHP)来管理 高危患者在上了锁的医院单元外。如今，IOP/PHP服务在某些领域被频繁使用 作为患者出院后的主要出院计划。然而，几乎没有证据表明 检查他们在这段时间内对自杀风险的临床效果。虽然这些IOP/PHP服务是现成的 在该国的一些地区，它们在其他地区几乎不存在。如果IOP/PHP服务具有 对出院后自杀有显著保护作用，实施措施扩大 在全国范围内提供这些服务，可以作为扭转反对自杀的曲线的一种方式。 我们假设，IOP/PHP的强烈社会和心理支持将反映在 通过这些计划接受治疗的患者的自杀风险降低。我们将对此进行测试 通过对接受治疗的患者进行倾向评分匹配的观察性研究来进行假设 出院后眼压/眼压服务与接受非强化门诊随访的患者进行比较。 这些群体的队列将足够大(每组超过100,000)，以检测出即使是微小的差异 干预组之间的自杀率(最低可检测比率范围为0.82至0.95，见表 4)。该项目的数据将从医疗补助数据库中提取，并将与国家死亡 该指数是美国最权威的死亡率数据来源。 此外，我们将对IOP/PHP服务的临床总监进行全国调查，以确定和 确定临床护理流程的特点。调查结果将与基于索赔的分析相结合，以更好地 了解哪些护理流程可以有效降低出院后的自杀风险 以了解全国各IOP/PHP服务在护理质量方面的差异。 该项目的结果将对政策和排放规划模式产生重要影响 在住院后期间。今后的方向将包括传播和执行倡议。 使出院计划模式与临床证据保持一致。在此期间将成立一个利益相关者理事会 帮助实施战略，以提高这些服务在其所在地的可用性的项目 不是广泛可及的。

ABSTRACT Suicide is a top ten cause of mortality in the United States, and suicide rates have increased dramatically in recent decades. A recent meta-analysis showed that the suicide rate following discharge from a psychiatric facility was 2,078 per 100,000 person-years (versus 14.0 for the general population). Approximately one- quarter of all suicide deaths occur within 3 months of discharge from a psychiatric facility, making this a period of extremely high risk. With the advent of managed care in the 1990s and the concomitant decrease in hospital lengths of stay, Intensive Outpatient Programs/Partial Hospitalization Programs (IOP/PHPs) were instituted to manage high-risk patients outside of a locked hospital unit. Today, IOP/PHP services are frequently used in some areas as the principal discharge plan for patients upon leaving the hospital. However, there is virtually no evidence examining their clinical effects on suicide risk in this period. While these IOP/PHP services are readily available in some areas of the country, they are virtually non-existent in other regions. If IOP/PHP services have a significant protective effect against suicide following hospital discharge, implementation initiatives to broaden the availability of these services nationwide could be undertaken as a way to bend the curve against suicide. We hypothesize that the intense social and psychological support of IOP/PHPs will be reflected in a reduction in suicide risk among patients who receive treatment through these programs. We will test this hypothesis by conducting a propensity score matched observational study of patients who receive treatment at IOP/PHP services following discharge compared to patients who receive non-intensive outpatient follow-up. Cohorts for these groups will be sufficiently large (over 100,000 per group) to detect even small differences in suicide rates between intervention groups (minimum detectable rate ratio ranging from 0.82 to 0.95, see Table 4). The data for this project will be drawn from Medicaid databases and will be linked with the National Death Index, the most authoritative data source for mortality in the United States. Additionally, we will conduct a national survey of clinical directors of IOP/PHP services to identify and characterize clinical care processes. Survey results will be integrated with claims-based analyses to better understand what care processes may be effective in reducing suicide risk following hospital discharge as well as to understand the variations in quality of care throughout the country among IOP/PHP services. Results from this project would have important implications for policy and discharge planning patterns in the post-hospitalization period. Future directions would include dissemination and implementation initiatives to align discharge planning patterns with clinical evidence. A stakeholder council will be formed during the project to help implement strategies to enhance the availability of these services in locations where they are not widely accessible.