Jt Comm J Qual Patient Saf. 2022 Oct;48(10):503-512. doi: 10.1016/j.jcjq.2022.02.009. Epub 2022 Mar 6.
Suicide after psychiatric hospitalization is a major concern. Poor treatment engagement may contribute to risk. The World Health Organization Brief Intervention and Contact (BIC) Program is an evidence-based practice shown to prevent suicide after psychiatric discharge in international trials. There have been no efforts to implement BIC into routine practice in US populations.
The authors conducted a 12-month quality improvement (QI) collaborative at six US Department of Veterans Affairs (VA) medical centers serving a large rural population. Sites had low to moderate performance on a VA quality measure of mental health postdischarge care; a measure assessing the proportion of discharged patients who achieve the required number of visits ≤ 30 days. Sites received programmatic support to implement BIC locally. Implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.
Overall, teams had high participation in programmatic activities and enrolled 85% of eligible patients that they approached. Among 70 enrolled patients, 81.4% achieved the VA quality measure of mental health postdischarge care, suggesting good treatment engagement. On average, patients rated BIC as excellent. Team members agreed that BIC was easy to use, implementable, possible, and doable. Factors facilitating implementation included standardized operating procedures to standardize processes. Barriers included insufficient staffing and loss to follow-up. Most sites plan to continue to enroll patients and to expand BIC to other areas.
A QI collaborative can facilitate implementation of BIC in six VA facilities that provide inpatient psychiatric treatment. BIC may appeal to patients and providers and may improve treatment engagement.
精神病院出院后的自杀是一个主要问题。治疗参与度低可能会增加风险。世界卫生组织的简短干预和联系（BIC）计划是一种循证实践，已在国际试验中证明可以预防精神病出院后的自杀。在美国人群中，尚未努力将 BIC 纳入常规实践。
作者在美国 6 家退伍军人事务部（VA）医疗中心进行了为期 12 个月的质量改进（QI）合作，这些中心为一个大型农村地区提供服务。这些地点在 VA 衡量精神卫生出院后护理质量的指标上表现不佳，该指标评估出院患者中达到规定就诊次数（≤30 天）的比例；这些地点获得了在当地实施 BIC 的计划支持。实施情况使用 Reach、Effectiveness、Adoption、Implementation、Maintenance（RE-AIM）框架进行评估。
总体而言，团队在计划活动中的参与度很高，他们接触到的符合条件的患者中有 85%参与了项目。在 70 名入组患者中，有 81.4%达到了 VA 衡量精神卫生出院后护理质量的指标，表明治疗参与度良好。平均而言，患者对 BIC 的评价为优秀。团队成员一致认为 BIC 易于使用、可实施、可行且可操作。促进实施的因素包括标准化操作程序，以标准化流程。障碍包括人员配备不足和随访流失。大多数地点计划继续招募患者，并将 BIC 扩展到其他领域。
QI 合作可以促进 BIC 在六家提供住院精神病治疗的 VA 设施中的实施。BIC 可能会吸引患者和提供者，并可能提高治疗参与度。
