Ahmedani Brian K, Coffey Justin, Coffey C Edward
Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI 48202. E-mail:
Am J Manag Care. 2013 Nov 1;19(11):e386-90.
To evaluate the use of government mortality records compared with internally collected data to drive quality improvement in suicide prevention programs using suicide mortality data from the Perfect Depression Care initiative.
Perfect Depression Care (PDC) is a quality improvement suicide prevention initiative within the Behavioral Health Services (BHS) division of the Henry Ford Health System. Eligible subjects were all patients who received services from BHS, were members of the health maintenance organization, and had a medical group physician during the 11-year study period. Mortality data were collected internally and from government-collected death records, and were linked to treatment utilization data from the medical record.
The mean suicide rate was 96.6 per 100,000 during the 2-year baseline period (1999- 2000) and declined to 19.1 per 100,000 during the initiative (2002-2009) using both sources of data combined. We observed a similar statistically significant (P <.001) reduction in the suicide death rate using both the internal and government data sources. There were no significant differences between the 2 sources of data in the mean suicide rates for the baseline and intervention periods (P >.05). The data sources did differ in the capture of unique suicide deaths.
Internally collected data were an effective measure of suicide deaths in the PDC initiative. A combination of internal and government-collected records may be most effective for future suicide prevention programs.
利用“完美抑郁症护理”倡议中的自杀死亡率数据,评估将政府死亡率记录与内部收集的数据相比较,以推动自杀预防项目质量改进的情况。
“完美抑郁症护理”(PDC)是亨利·福特医疗系统行为健康服务(BHS)部门内的一项质量改进自杀预防倡议。符合条件的受试者为在11年研究期间接受过BHS服务、是健康维护组织成员且有医疗集团医生的所有患者。死亡率数据通过内部收集以及从政府收集的死亡记录中获取,并与病历中的治疗利用数据相关联。
在2年基线期(1999 - 2000年),平均自杀率为每10万人96.6例,在倡议实施期间(2002 - 2009年),综合使用两种数据来源后,自杀率降至每10万人19.1例。使用内部和政府数据源,我们均观察到自杀死亡率有类似的统计学显著降低(P <.001)。在基线期和干预期的平均自杀率方面,两种数据来源之间无显著差异(P >.05)。两种数据来源在独特自杀死亡病例数的记录上存在差异。
在“完美抑郁症护理”倡议中,内部收集的数据是自杀死亡的有效衡量指标。对于未来的自杀预防项目,内部记录与政府收集的记录相结合可能最为有效。