Project Name:
Developing Tools to Evaluate the Impact of Safety Planning and Lethal Means Assessment on Suicide Outcomes

Principal Investigator:
Brian Ahmedani PhD
Jennifer M Boggs, MSW, PhD (Primary Contact)

Principal Investigator Contact Information: 
BAHMEDA1@hfhs.org         

Principal Investigator Institution:
Henry Ford Health System

Funder:
NIMH

Funding Period:
07/14/2018 – 7/31/2020

Abstract:
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.        

Grant Number:
3U01MH114087-02S1 REVISED

Participating Sites:
Henry Ford Health System
Kaiser Permanente Colorado  
Kaiser Permanente Northwest

Investigators:
Jennifer M Boggs, MSW, PhD(c)
BobbiJo Yarborough, PsyD
Arne Beck, PhD

Major Goals:

  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 at three Zero Suicide sites 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.

Description of study sample:
Our study sample will include patients at risk for suicide who were members of the Kaiser Permanente Colorado (KPCO), Kaiser Permanente Northwest (KPNW) or Henry Ford Health System (HFHS) for at least 1 year. 
For all aims, patients must meet one (or both) of these two criteria defining an index event between 2013 - 2017:

  1. endorsement of the suicide question (item 9) of the PHQ9 depression questionnaire
  2. suicide attempt coded in the emergency department/hospital

Current Status:
09/26/2018 – The project was recently funded and is in the process of completing regulatory applications at all of the sites.

Study Registration:
N/A

Publications:
N/A

Resources:
N/A

Lessons Learned:
N/A
What's next?
We have developed an initial program to identify the cohort at each site and will distribute this when all sites have achieved regulatory approvals, hopefully by October 1, 2018.  Chart reviewer training documents have been developed and distributed to all sites.  A chart reviewer training has been scheduled for early October.  We hope to complete the phase 1 chart review before the end of 2018.