Development and Validation of Electronic Health Record Measures of Safety Planning Practices as Part of Zero Suicide Implementation.

IF 2.5 3区 医学 Q2 PSYCHIATRY
Jennifer M Boggs, Bobbi Jo H Yarborough, Gregory Clarke, Erica M Aguirre-Miyamoto, Lee J Barton, Arne Beck, Cambria Bruschke, Stuart Buttlaire, Karen J Coleman, Jean P Flores, Robert Penfold, J David Powers, Julie Angerhofer Richards, Laura Richardson, Arthur Runkle, Jacqueline M Ryan, Gregory E Simon, Stacy Sterling, Christine Stewart, Scott Stumbo, LeeAnn M Quintana, Hsueh-Han Yeh, Brian K Ahmedani
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引用次数: 0

Abstract

Objective: Safety planning for suicide prevention is an important quality metric for Zero Suicide implementation. We describe the development, validation, and application of electronic health record (EHR) programs to measure uptake of safety planning practices across six integrated healthcare systems as part of a Zero Suicide evaluation study.

Methods: Safety planning was documented in narrative notes and structured EHR templates using the Stanley Brown Safety Planning Intervention (SBSPI) in response to a high-risk cutoff score on the Columbia Suicide Severity Rating Scale (CSSRS). Natural Language Processing (NLP) metrics were developed and validated using chart review to characterize practices documented in narrative notes. We applied NLP to measure frequency of documentation in the narrative text and standard programming methods to examine structured SBSPI templates from 2010-2022.

Results: Chart reviews found three safety planning practices documented in narrative notes that were delivered to at least half of patients at risk: professional contacts, lethal means counseling for firearms, and lethal means counseling for medication access/storage. NLP methods were developed to identify these practices in clinical text with high levels of accuracy (Sensitivity, Specificity, & PPV ≥ 82%). Among visits with a high-risk CSSRS, 40% (Range 2-73% by health system) had an SBSPI template within 1 year of implementation.

Conclusions: This is one of the first reports describing development of measures that leverage electronic health records to track use of suicide prevention safety plans. There are opportunities to use the methods developed here in future evaluations of safety planning.

作为 "零自杀 "实施工作的一部分,开发和验证安全规划实践的电子健康记录措施。
目标:预防自杀的安全规划是实施 "零自杀 "的重要质量指标。作为 "零自杀 "评估研究的一部分,我们介绍了电子健康记录(EHR)程序的开发、验证和应用,以衡量六个综合医疗保健系统对安全规划做法的接受程度:方法:根据哥伦比亚自杀严重程度分级表(CSSRS)的高风险临界值,使用斯坦利-布朗安全规划干预(SBSPI)在叙述性笔记和结构化电子病历模板中记录安全规划。我们开发了自然语言处理 (NLP) 指标,并通过病历审查进行了验证,以描述叙述性笔记中记录的实践特征。我们应用 NLP 测量了叙述性文字中的记录频率,并采用标准编程方法检查了 2010-2022 年期间的结构化 SBSPI 模板:病历审查发现,至少有一半的高危患者在叙述性病历中记录了三种安全规划实践:专业联系、枪支致命手段咨询和药物获取/储存致命手段咨询。我们开发了 NLP 方法,以高精度(灵敏度、特异性和 PPV ≥ 82%)识别临床文本中的这些做法。在具有高风险 CSSRS 的就诊者中,40%(按医疗系统划分的范围为 2-73%)在实施后 1 年内拥有 SBSPI 模板:这是首批介绍利用电子健康记录追踪自杀预防安全计划使用情况的措施的报告之一。在未来的安全计划评估中,我们有机会使用在此开发的方法。
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来源期刊
CiteScore
6.10
自引率
7.10%
发文量
69
期刊介绍: Archives of Suicide Research, the official journal of the International Academy of Suicide Research (IASR), is the international journal in the field of suicidology. The journal features original, refereed contributions on the study of suicide, suicidal behavior, its causes and effects, and techniques for prevention. The journal incorporates research-based and theoretical articles contributed by a diverse range of authors interested in investigating the biological, pharmacological, psychiatric, psychological, and sociological aspects of suicide.
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