Evaluating the Impact of Changes in Opioid Prescribing Across Health Systems Implementing Zero Suicide

这一及时的补充将支持我们的目标，目前的奖项：评估国家零 自杀模型跨学习医疗保健系统（U 01 MH 114087）通过利用自然实验， 计划在五个国家的行为健康部门推出安全规划模板 2019年的Kaiser Permanente地区和亨利福特健康系统。安全规划是一个强烈建议 在零自杀（ZS）框架内的实践，但对个人的有效性知之甚少 可以构成安全计划的要素，如致命手段评估， 接触、应对技巧、警告信号和分心来源。目前的零自杀奖建议， 使用阶梯楔形中断时间，审查安全规划和致命手段评估的影响， 系列（ITS）方法，将每个变量作为二元变量进行测量（例如，是否进行了安全规划）。的ITS 这种方法要求某些场所实施安全规划（安全规划的干预场所）， 其他则没有（安全规划控制场地）。如果不进一步研究，所提出的ITS方法现在是有问题的。 工作有两个原因：1）所有凯撒永久网站和亨利福特已决定统一实施 安全规划大约在同一时间，因此没有控制站点2）没有控制站点， 能够准确测量基线时安全规划/致命手段评估的变化， 纵向此后将使我们的评估发生，但所有的文件生活在文本- 基于临床叙述。在与我们的卫生系统领导零自杀指标的发展， 我们被告知，安全规划和致命手段评估的基准率不是零， 但实际比率未知。此补充将支持使用Natural开发新指标 语言处理，以确定基线率，从中，我们可以量化的变化，在安全规划 在实施新的安全规划模板后， 使用我们的零自杀主奖。此外，我们建议利用新实施的 模板，以解决一个重要的调解人的影响，安全规划自杀的结果， 对新模板的忠实度，我们将其定义为质量、完整性和与正在进行的 在乎我们提出了以下三个具体目标的补充工作：1）确定关键术语的安全 规划和致命手段评估1）开发自然语言处理（NLP）指标，以评估 在三个零自杀地点进行安全规划和致命手段评估2）实施NLP 确定安全规划和致命手段评估的查询，并测量基线率3） 在医疗记录中实施电子安全规划模板，制定和实施指标 使用NLP评估安全规划模板的保真度（完整性，质量，与护理的集成）。

This timely supplement would support our goals for the current award: An Evaluation of the National Zero Suicide Model Across Learning Healthcare Systems (U01MH114087) by capitalizing on a natural experiment, the planned the national roll-out of safety planning templates in behavioral health departments across five Kaiser Permanente regions and Henry Ford Health System in 2019. Safety planning is a highly recommended practice within the Zero Suicide (ZS) framework, but little is known about the effectiveness of the individual elements that can make up a safety plan, such as lethal means assessment, identification of supportive contacts, coping skills, warning signs, and sources of distraction. The current Zero Suicide award proposes to examine the impact of safety planning and lethal means assessment using a stepped-wedged interrupted time- series (ITS) approach, measuring each as a binary variable (e.g. safety planning did or did not occur). The ITS approach requires that some sites implement safety planning (intervention sites for safety planning), while others do not (control sites for safety planning). The proposed ITS approach is now problematic without further work for two reasons: 1) All Kaiser Permanente sites and Henry Ford have decided to uniformly implement safety planning around the same time, therefore there are no control sites 2) Without control sites, metrics that can accurately measure variation in safety planning/lethal means assessment at baseline and then longitudinally thereafter would enable our evaluation to take place, but all of the documentation lives in text- based clinical narratives. In working with our health system leads on the development of Zero Suicide metrics, we have been informed that the rate for safety planning and lethal means assessment at baseline is not zero, but the actual rate is unknown. This supplement will support development of new metrics using Natural Language Processing to determine baseline rates, from which, we can quantify the change in safety planning and lethal means assessment practice longitudinally after implementation of new safety planning templates using our Zero Suicide main award. Furthermore, we propose to take advantage of the newly implemented templates to address an important mediator of the effect of safety planning on suicide outcomes, the impact of fidelity to the new templates, which we define as quality, completeness, and level of integration with ongoing care. We propose the following three specific aims for this supplemental work: 1) Identify key terms for safety planning and lethal means assessment 1.) Develop Natural Language Processing (NLP) metrics to assess the occurrence of safety planning and lethal means assessment at three Zero Suicide sites 2) Implement NLP queries for identification of safety planning and lethal means assessment and measure baseline rates 3) Upon implementation of electronic safety planning templates in medical records, develop and implement metrics using NLP for assessing fidelity (completeness, quality, integration with care) to safety planning templates.