Dillon Ellis C, Deng Sien, Li Martina, Huang Qiwen, de Vera Ernell, Pesa Jacqueline, Nguyen Tam, Kiger Anna, Becker Daniel F, Azar Kristen
Center on Aging University of Connecticut Health Center Farmington Connecticut USA.
Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute Sutter Health Palo Alto California USA.
Psychiatr Res Clin Pract. 2024 Apr 3;6(2):51-60. doi: 10.1176/appi.prcp.20230068. eCollection 2024 Summer.
Sutter Health launched system-wide general population standardized suicide screening with the Columbia-Suicide Severity Rating Scale (C-SSRS) screen (triage) version in 23 hospitals in 2019, replacing a one-question "danger to self" (DTS) assessment. This study analyzed the impact of C-SSRS implementation on screening rates, positive screenings, and documented psychiatric care within 90 days for all patients and a subgroup diagnosed with Major Depressive Disorder (MDD).
Adults seen at hospitals in the pre-period (July 1, 2017-June 30, 2019) and post-period (July 1, 2019-December 31, 2020) were identified using electronic health records. Outcomes were compared using chi-square statistics and interrupted time series (ITS) models.
Pre-period, 92.8% (740,984/798,653) of patients were screened by DTS versus 84.6% (504,015/595,915) by C-SSRS in the post-period. Positive screening rates were 1.5% pre-period and 2.2% post-period, and 9.2% pre-period versus 10.8% post-period for those with MDD. Among individuals with positive screenings, 64.0% (pre-period) had documented follow-up psychiatric care versus 52.5% post-period and 66.4% of those with moderate or high-risk. Among all patients seen there was an overall increase in documentation of psychiatric care within 90 days (0.87% pre- to 0.96% post-period). ITS models revealed a 9.6% decline in screening, 1.3% increase in positive screenings, and 12.9% decline in documented psychiatric care following C-SSRS implementation (all < 0.01).
Following implementation, there was meaningful increase in suicide risk identification, and an increase in the proportion of patients with documented psychiatric care. Observed relative declines in screening warrant future research examining opportunities and barriers to general population C-SSRS use.
萨特健康系统于2019年在23家医院推出了全系统的一般人群标准化自杀筛查，采用哥伦比亚自杀严重程度评定量表（C-SSRS）筛查（分诊）版本，取代了一个问题的“对自我的危险”（DTS）评估。本研究分析了实施C-SSRS对所有患者以及被诊断为重度抑郁症（MDD）的亚组患者在90天内的筛查率、阳性筛查结果和有记录的精神科护理的影响。
利用电子健康记录识别在前期（2017年7月1日至2019年6月30日）和后期（2019年7月1日至2020年12月31日）在医院就诊的成年人。使用卡方统计和中断时间序列（ITS）模型比较结果。
前期，92.8%（740,984/798,653）的患者通过DTS进行了筛查，而后期通过C-SSRS进行筛查的比例为84.6%（504,015/595,915）。前期阳性筛查率为1.5%，后期为2.2%；MDD患者前期为9.2%，后期为10.8%。在筛查呈阳性的个体中，64.0%（前期）有记录的后续精神科护理，而后期为52.5%，中度或高风险者为66.4%。在所有就诊患者中，90天内精神科护理记录总体有所增加（前期为0.87%，后期为0.96%）。ITS模型显示，实施C-SSRS后，筛查下降了9.6%，阳性筛查增加了1.3%，有记录的精神科护理下降了12.9%（均P<0.01）。
实施后，自杀风险识别有了显著增加，有记录的精神科护理患者比例也有所增加。观察到的筛查相对下降值得未来研究探讨一般人群使用C-SSRS的机会和障碍。
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