Tag: Implementation and evaluation research

Evaluating Zero Suicide Care Improvement Programs in MHRN Health Systems

Grant Details

Title: An Evaluation of the National Zero Suicide Model Across Learning Healthcare Systems

Funder: NIMH

Grant Number: 1U01MH114087

Grant Period: 08/03/2017 – 05/31/2022

Narrative: Health systems at six participating sites have all committed to developing and implementing various components of a National Zero Suicide Model (NZSM), originally developed at the lead site for this study, Henry Ford Health System (HFHS).  Each health system will decide which components to implement at their respective site.  This study will develop metrics to measure fidelity and outcomes for the NZSM components implemented in each system using EHR and insurance claims data.  The project will then use these metrics to conduct fidelity and outcome evaluation of the various NZSM approaches in each system using an Interrupted Time Series Design.

Short-term project objectives:

We seek to accomplish three specific aims:

  1. Collaborate with health system leaders across sites to develop EHR metrics to measure specific quality improvement targets and care processes tailored to local NZSM implementation.
  2. Examine the fidelity of the specific NZSM care processes implemented in each system.
  3. Investigate suicide attempt and mortality outcomes within and across NZSM system models.

Long-term project objectives:

Learnings from this study will be immediately available on the Zero Suicide and MHRN websites, shared directly with SAMHSA and NIMH (thru the MHRN), and disseminated broadly to health systems via Zero Suicide Training Academies well before published data are available. As such, our goal is rapid dissemination and translation to practice, as opposed to the standard research-to-practice model – which the NIH and others estimate can take 17 years.

  • Lead Site:
    • Overall PI: HFHS Brian Ahmedani
  • Participating Sites/Subcontractors:
    • KPWA (site PI Greg Simon)
    • KPCO (site PI Jennifer Boggs)
    • KPNW (site PI Greg Clarke)
  • Funder Contacts
    • Science Officer: Susan Azrin
    • Program Official: Michael Freed
    • Grants Management Official: Julie Bergerud

Documents & Reports

Funding Announcement

Personnel Contact List

Publications

Manuscripts in process

ZS manuscript tracker: https://airtable.com/shr7wfbafq5c1rwTY

MHRN manuscript proposal form: https://airtable.com/shrD81CbLqaRrF8ga

Automated Virtual Follow-Up to Reduce Premature Treatment Discontinuation

Project Name:
Automated Virtual Follow-Up to Reduce Premature Treatment Discontinuation
Grant Number:
 U19MH092201 (Pilot study under MHRN II)
Principal Investigator:
Robert Penfold, PhD
Principal Investigator Contact Information:          
robert.b.penfold@kp.org
Funder
NIMH
Funding Period:
07/2017 – 06/2019
Abstract:
Recent developments in health informatics have created the potential for more efficient and more targeted outreach programs to address dropout from depression treatment.  First, electronic medical records databases allow real-time evaluation of patients who are “overdue” for prescription refills and follow-up visits.  Second, increasing use of standardized depression severity measures (such as the PHQ9), allow efficient identification of those at risk for unfavorable outcomes.  Third, increasing use of patient-provider online messaging will permit much more efficient outreach communication.  We are conducting a pilot study of a semi- automated outreach program for adult outpatients who appear to have dropped out of acute-phase depression treatment (either pharmacotherapy or psychotherapy). Participants with missed antidepressant refills or missed psychotherapy sessions are emailed a short questionnaire to ask about their intentions for treatment as well as a PHQ9, GAD2, and AUDIT-C. Feedback on patients’ answers is delivered immediately in a web-based format.
Participating Sites:                                       
Kaiser Permanente Washington (Lead Site)
Kaiser Permanente Colorado
Investigators:
Robert Penfold, PhD
Arne Beck, PhD
Major Goals:
Conduct a pilot study of a completely automated outreach program for adult outpatients who appear to have dropped out of acute-phase depression treatment (either pharmacotherapy or psychotherapy).
Description of study sample:
The study population will include up to 2400 adult patients in participating health systems who initiate medication or psychotherapy treatment for depression.   
Current Status:
Health record data were used to identify KP adult members eligible for outreach with a new depression diagnosis who have started therapy and appear to have discontinued prematurely, but do not have a recorded good outcome (most recent PHQ9 on record total score is >=10). A secure outreach message, including a link to an externally hosted questionnaire in Research Electronic Data Capture (REDCap) was sent to identified subjects through kp.org (i.e., MyChart). The study questionnaire was comprised of (2) standard assessments used for depression and suicide risk screening and a number of treatment- specific questions.PHQ9- standard assessment measuring depression severityCSSR-S- standard assessment measuring severity of suicidal ideation/ behavior. Depression Treatment Discontinuation QuestionsSubjects who returned the questionnaire were provided tailored feedback, ranging from “glad to hear that you are planning to continue care” to “we’d like to see you feeling better/we want to make sure that you are receiving the care you need- please consider scheduling an appt.” The web-based consent process and survey were hosted on KPCO’s internal instance of Research Electronic Data Capture (REDCap)All patient recruitment and outreach activities are complete. Data collection is complete. During the recruitment phase we identified and enrolled 988 subjects meeting study criteria for initiating psychotherapy. After ongoing monitoring of enrolled subjects, 657 subjects were flagged as potentially discontinuing psychotherapy treatment early. Subjects flagged by the automated algorithm as potential ‘early discontinuers’ were manually reviewed for meeting ‘discontinuation of treatment’ study criteria. After manual review, 518 qualified subjects were outreached through the electronic health record with an invitation to complete the depression treatment questionnaire. 70 of the 518 qualified subjects who were sent an invitation to complete the depression treatment questionnaire- responded.63 fully completed AND 7 people who consented but did not fully complete all components of the questionnaire.
Study Registration:
N/A – study hasn’t started yet
Publications:
N/A
Resources:
N/A
Lessons Learned:
N/A
What’s next?
N/A

Care of Mental, Physical and Substance Use Syndromes (COMPASS)

Project Name:
Care of Mental, Physical and Substance Use Syndromes (COMPASS)
Principal Investigator:
Sanne Magnan, MD PhD; Evaluation Director: Leif Solberg, MD
Principal Investigator Contact Information:
sannemagnan@gmail.com; Leif.I.Solberg@Healthpartners.com
Principal Investigator institution:
Institute for Clinical Systems Improvement; HealthPartners Institute
Funder
Centers for Medicare & Medicaid Services (CMS) / Center for Medicare & Medicaid Innovation (CMMI)
Funding Period:
07/2012 – 06/2015
Abstract:
Health care increasingly needs to develop ways to manage individuals with multiple coexisting chronic conditions. COMPASS is a partnership among 9 organizations and 18 care delivery systems nationally to implement the Collaborative Care model for patients in primary care suffering from depression as well as diabetes and/or cardiovascular disease that are not under control. The initiative reached approximately 4,000 patients in seven states, and improved depression in 40% and achieved control in 23% with diabetes and 58% with hypertension while improving patient satisfaction with care and physician satisfaction with the resources needed to manage such patients.
Grant Number:
CMS-ICI-12-001
Participating Sites:               
AIMS (Advancing Integrated Mental Health Solutions) Center at the University of Washington
Community Health Plan of Washington (CHPW)
HealthPartners Institute
Kaiser Permanente Colorado (KPCO)
Kaiser Permanente Southern California (KPSC)
Michigan Center for Clinical Systems Improvement (Mi-CCSI)
Mount Auburn Cambridge Independent Practice Association (MACIPA)
Pittsburgh Regional Health Initiative (PRHI)
Institute for Clinical Systems Improvement (ICSI)
Investigators:
Sanne Magnan, MD, PhD
Claire Neeley, MD
Leif Solberg, MD
Arne Beck, PhD
Karen Coleman, PhD
Jurgen Unutzer, MD
Rebecca Rossom, MD, MS
Lauren Crain, PhD
Michael Maciosek, PhD
Robin Whitebird, PhD, MSW, LISW
Major Goals:
The major goals are to increase the proportion of these complex uncontrolled patients who are now under control by 20% for patients with diabetes or hypertension, and to improve depression in 40%, while reducing healthcare costs
Description of study sample:
This was a demonstration project aimed at adults with active depression plus either diabetes or cardiovascular disease that were not under control. We initially targeted patients with Medicare or Medicaid, but later added other patient groups because of the unexpected difficulty of identifying and recruiting such patients.
Current Status:
The project was completed in 6/15, but most participating medical groups have continued it with a variety of modifications to fit their settings and needs
Study Registration:
N/A
Publications:
Coleman KJ, Hemmila T, Valenti MD, Smith 4, Quarrell R, Ruona LK, Brandenfels E, Hann B, Hinnenkamp T, Parra MD, Monkman J, Vos S, Rossom RC. Understanding the experience of care managers and relationship with patient outcomes: the COMPASS initiative. Gen Hosp Psychiatry. 2016 Aug 18. pii: S0163-8343(16)30164-5. doi: 10.1016/j.genhosppsych.2016.03.003. [Epub ahead of print]Coleman KJ, Magnan S, Neely C, Solberg L, Beck A, Trevis J, Heim C, Williams M, Katzelnick D, Unützer J, Pollock B, Hafer E, Ferguson R, Williams S. The COMPASS initiative: description of a nationwide collaborative approach to the care of patients with depression and diabetes and/or cardiovascular disease. Gen Hosp Psychiatry. 2016 Aug 18. pii: S0163-8343(16)30166-9. doi: 10.1016/j.genhosppsych.2016.05.007. [Epub ahead of print]Rossom RC, Solberg LI, Magnan S, Crain AL, Beck A, Coleman KJ, Katzelnick D, Williams MD, Neely C, Ohnsorg K, Whitebird R, Brandenfels E, Pollock B, Ferguson R, Williams S, Unützer J. Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease. Gen Hosp Psychiatry. 2016 Aug 18. pii: S0163-8343(16)30165-7. doi: 10.1016/j.genhosppsych.2016.05.006. [Epub ahead of print]Solberg LI, Ferguson R, Ohnsorg KA, Crain AL, Williams MD, Ziegenfuss JY, et al. The challenges of collecting and using patient care data from diverse care systems: lessons from COMPASS. Am J Med Qual 2017;32(5):494-499.Whitebird RR, Solberg LI, Crain AL, Rossom RC, Beck A, Neely C, Dreskin M, Coleman KJ. Clinician burnout and satisfaction with resources in caring for complex patients. Gen Hosp Psychiatry. 2017;44(1):91-95. Jul 16. pii: S0163-8343(16)30167-0. doi: 10.1016/j.genhosppsych.2016.03.004. [Epub ahead of print]Solberg LI, Ohnsorg KA, Parker ED, Ferguson R, Magnan S, Whitebird RR, Neely C, Brandenfels E, Williams MD, Dreskin M, Hinnenkamp T, Ziegenfuss JY. Preventable hospital and emergency department events: lessons from a large innovation project. The Permanente Journal 2018 (In press).
Resources:
N/A
Lessons Learned:
It is possible to have multiple diverse health care organizations collaborate on a common improvement project and to use a common data system to aggregate data for reporting and analysis, although there are many challenges to doing so. Other lessons are available in the above publications. Additional publication in development describes the relation between care manager contacts and systematic case review to depression improvement.
What’s next?
Most participating organizations are continuing to use individually adapted versions of the COMPASS model for care but there will be no follow-on group project.

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

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
BobbiJo Yarborough, PsyD
Arne Beck, PhD
Major Goals: Develop Natural Language Processing (NLP) metrics to assess the occurrence of safety planning and lethal means assessment at three Zero Suicide sites. Implement NLP queries for identification of safety planning and lethal means assessment at three Zero Suicide sites and measure baseline rates. 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:endorsement of the suicide question (item 9) of the PHQ9 depression questionnaire 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.

Evaluating the Impact of Changes in Opioid Prescribing across Health Systems Implementing Zero Suicide

Project Name:
Evaluating the Impact of Changes in Opioid Prescribing across Health Systems Implementing Zero Suicide
Principal Investigator:
Brian Ahmedani PhD (Contact PI)
Principal Investigator Contact Information: 
BAHMEDA1@hfhs.org         
Principal Investigator Institution:
Henry Ford Health System
Funder:
NIMH
Funding Period:
09/08/2018 – 09/07/2019
Abstract:
Suicide is a major public health concern – it is the 10th leading cause of death and number one cause of injury-related death in the United States (US). Suicide rates have risen over 25% in the last 15 years.  In parallel, the nation is struggling with an opioid epidemic.  Opioid prescribing, heroin use, and opioid-related overdose deaths have risen substantially.  Approximately 15% of all suicide deaths are due to drug overdose, and prescription opioids specifically, are commonly used among people who attempt suicide.  Health systems across the country have made decisions to tackle both of these public health crises – implementing policies to dramatically reduce opioid prescribing as well as clinical processes within the Zero Suicide model to improve suicide prevention for their patients. The parent award for this supplement is focused on evaluation of Zero Suicide implementation, including fidelity to each of these clinical processes and suicide outcomes, across 6 large, diverse Mental Health Research Network-affiliated Learning Healthcare Systems providing healthcare for over 9 million individuals each year. Given the overlap, significant reductions in opioid prescribing as part of newly implemented policies should lead to a reduction in the availability of opioids.  These reductions may result in a public-health level means reduction approach to reduce suicide.  Means reduction is among the interventions recommended within Zero Suicide.  The concurrent implementation of these new opioid prescribing policies in the context of implementation of Zero Suicide allows the opportunity to evaluate how changes in opioid prescribing impacts suicide outcomes in health care. This supplement project seeks to accomplish three specific aims: 1) Evaluate changes in opioid prescribing patterns during the period of NZSM implementation across health systems, 2) Investigate whether changes in opioid prescribing patterns reduce suicide attempt and mortality, and 3) Investigate whether changes in opioid prescribing patterns reduce opioid-related suicide attempt and mortality poisonings. Overall, we propose to use an Interrupted Time Series Design, consistent with the parent award, to measure changes in prescribing patterns and suicide outcomes.
Grant Number:
U01MH114087-02S2
Participating Sites:
Henry Ford Health System
Kaiser Permanente Washington
Kaiser Permanente Colorado  
Kaiser Permanente Northern California
Kaiser Permanente Northwest
Kaiser Permanente Southern California
Investigators:
Gregory Simon, MD, MPH (co-PI)
BobbiJo Yarborough, PsyD
Stacy Sterling, DrPH
Karen Coleman, PhD
Arne Beck, PhD
Major Goals: Evaluate changes in opioid prescribing patterns during the period of NZSM implementation across health systems. Investigate whether changes in opioid prescribing patterns reduce suicide attempt and mortality. Investigate whether changes in opioid prescribing patterns reduce opioid-related suicide attempt and mortality poisonings.
Description of study sample:
N/A
Current Status:
06/26/2019 – We have finalized the study protocol and methods, including finalizing the data metrics.  We have drafted the specifications for the program to extract the electronic health record data from the participating sites.
Study Registration:
N/A
Publications:
N/A
Resources:
N/A
Lessons Learned:
N/A
What’s next?
We will finalize the program specifications, write/test/distribute the program, and collect the final data for analyses

Firearms means restriction for suicide prevention in pediatric primary care

Project Name:
Intervention mapping to develop multi-level implementation strategies in partnership with stakeholders: Firearms means restriction for suicide prevention in pediatric primary care
Principal Investigator:
Rinad Beidas, PhD
Principal Investigator Contact Information:
rbeidas@upenn.edu
Principal Investigator institution:
University of Pennsylvania
Funder:
NIMH
Funding Period:
05/2016 – 07/2018
Abstract:
Suicide is a leading cause of death in children and adolescents and a critical public health concern. One promising suicide prevention strategy that is under-utilized includes reducing access to lethal means, or means restriction. Firearms are an important target for means restriction given that 1 in 3 homes possess a firearm and firearms are the most lethal manner by which suicide is attempted. Primary care is an ideal setting in which to provide firearms means restriction given that almost half of youth who die by suicide do not access specialty mental health services in the 12 months preceding their attempt. The Safety Check intervention is an evidence-based practice for implementing firearms means restriction in pediatric primary care (including pediatrics, family medicine, and adolescent medicine). Despite the existence of this intervention and recommendations from the American Academy of Pediatrics, providers rarely discuss means restriction or firearms during visits, suggesting the need for a better understanding of the barriers and facilitators to implementing means restriction in pediatric primary care. Implementation science frameworks, including the Consolidated Framework for Implementation Research (CFIR), suggest the importance of attending to multiple levels of context during implementation, including provider (e.g., self-efficacy), organizational (e.g., expectations about provider behavior), system (e.g., prompts in the electronic health records), and intervention (e.g., acceptability) factors. The NIMH-funded Mental Health Research Network (MHRN), a consortium of 13 healthcare systems across the United States, affords a unique opportunity to better understand how to implement means restriction in pediatric primary care from a system-level perspective. Our objective in this application is to collaboratively develop implementation strategies in partnership with MHRN stakeholders to increase the use of means restriction in pediatric primary care. In Aim 1, we will survey leadership and primary care providers of 96 primary care practices within 2 MHRN systems (Henry Ford Health System and Baylor Scott & White Health) to understand acceptability and use of the three components of the Safety Check intervention (i.e., screening, brief counseling around gun safety, and provision of gunlocks). In Aim 2, in collaboration with MHRN stakeholders in these 2 systems, we will use intervention mapping and the CFIR to systematically develop and evaluate a multi-level menu of implementation strategies for firearm means restriction in pediatric primary care. The proposed work is consistent with the NIMH strategic plan, specifically Objective 4, to strengthen the public health impact of NIMH-supported research, and will lead to a hybrid effectiveness-implementation R01 proposal. The long-term goal of this line of research is to reduce death by suicide by increasing the use of evidence-based strategies in pediatric primary care while also promoting multi-level implementation strategies informed by a systematic and rigorous development approach.
Grant Number:
1R21MH109878-01
Participating Sites:
Henry Ford Health System
Baylor Scott & White Health
Investigators:
Rinad Beidas, PhD
Brian Ahmedani, PhD
John Zeber, PhD
Steven Marcus, PhD
Courtney Benjamin Wolk, PhD
Shari Mintz, PhD
Joel Fein, MD, MPH
Gregory Brown, PhD
Major Goals:
To partner with MHRN stakeholders and engage in quantitative and qualitative inquiry around how to implement an evidence-based program for firearm safety as a suicide prevention strategy for youth in primary care.
Description of study sample: The sample for Aim 1 includes leaders from HFHS and BSW; and primary care providers from HFHS and BSW. 204 PCPs and 57 CLs were eligible for the survey; 103 (50.4%) PCPs and 40 (70.2%) CLs participated. The sample from Aim 2 includes 4-12 individuals from each of the following stakeholder groups (n=70): parents of youth that receive pediatric primary care at a HFHS clinic; physician providers; non-physician providers; leaders of primary care practices; leaders of behavioral health; leaders of quality improvement; system leaders; third-party payers, members of national credentialing bodies, and gun-owning constituents.
Current Status:9/27/18
Aim 1:
We collected quantitative primary data about the acceptability and use of the three EBPs in the survey, as reported previously. We also collected secondary data via publicly available data sources, including data from the MHRN virtual data warehouse and the National Center for Health Statistics’ National Vital Statistics System. Additionally, we extracted youth (aged 12-24) suicide deaths over the past five years by firearm at the county level for each primary care practice location from the National Vital Statistics System. We have submitted the manuscript summarizing Aim 1 findings, and it is currently under peer review. Aim 2:
We trained research staff and successfully conducted qualitative interviews for all stakeholder groups (n=70). We added a stakeholder group (gun-owning constituents) given our experiences with the qualitative interviews. We have completed all interviews and enrolled 7 parents, 7 primary care physicians, 7 non-physician providers, 7 clinical leaders, 6 system leaders, 6 leaders of behavioral health, 7 leaders of quality improvement, 4 third-party payers, 7 members of national credentialing bodies, and 12 gun owners. We evaluated all interviews to identify common themes related to barriers, facilitators, and implementation strategies. Upon gathering this information, we used the spirit of intervention mapping, in concert with the Consolidated Framework for Implementation Research (CFIR), to inform the development of a menu of implementation strategies. All interviews were transcribed and loaded into NVivo software for data management. Our team developed two different comprehensive coding schemes, one for the original set of stakeholders and one for gun-owner constituents, given that different themes emerged. We completed coding of all transcripts, and the coders maintained excellent reliability. From the interviews, we gleaned a number of themes around barriers, facilitators, and implementation strategies regarding the potential implementation of our intervention of interest. Overall, the interviews underscored the importance of considering how to best support providers to improve their self-efficacy and implement new practices (e.g. providing ongoing consultation, leveraging existing mental health screening/ suicide prevention initiatives), since providers are already overextended and have little time to implement additional practices. The manuscript is currently under review. Currently, we are preparing a manuscript specifically detailing the views of the gun-owner constituents,.Through the use of intervention mapping, we developed a list of implementation strategies, based off feedback from stakeholders who completed the qualitative interviews. After compiling the list, we returned to those original stakeholders and asked them to complete a brief online survey assessing feasibility, acceptability, and importance of each strategy. In total, we received 35 responses (roughly 69%). By administering the online survey, we were able to generate a refined list of the most feasible and acceptable implementation strategies under each level. We are currently drafting a manuscript that describes how our team selected the implementation strategies, using the process of intervention mapping.
Study Registration:
N/A
Publications:
Wolk CB, Jager-Hyman S, Marcus SC, Ahmedani BK, Zeber JE, Fein JA, Brown GK, Lieberman A, Beidas RS. Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study.  BMJ Open. 2017 Jun 24;7(6):e014407. doi: 10.1136/bmjopen-2016-014407.Jager-Hyman, S., Wolk, C. B., Ahmedani, B. K., Zeber, J. E., Fein, J. A., Brown, G. K., Byeon, Y. V., Listerud, H., Gregor, C. A., Lieberman, A., & Beidas, R. S. (in press). Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a universal suicide prevention strategy: A qualitative study. Journal of Behavioral Medicine.
Beidas, R. S., Jager-Hyman, S., Becker-Haimes, E., Wolk, C., Ahmedani, B., Zeber, J., Fein, J., Brown, G., Gregor, C., Lieberman, A., & Marcus, S.: Acceptability and use of evidence-based practices for firearm storage in pediatric primary care. Academic Pediatrics. November 2018.Wolk, C. B., Van Pelt, A., Jager-Hyman, S., Ahmedani, B., Zeber, J., Fein, J., Brown, G., Gregor, C., Lieberman, A., & Beidas, R. S.: Stakeholder perspectives on implementing a firearm safety intervention in pediatric primary care as a universal suicide prevention strategy: A qualitative study. JAMA Network Open. November 2018.Beidas, R.: How your child’s primary-care doctor can prevent gun injury and death. Philly.com. December 2018. (OP ED)
Resources:
N/A
Lessons Learned:
N/A
What’s next?
We will submit an application to NIMH in 2019 to conduct a hybrid trial evaluating both the effectiveness of the adapted Safety Check in pediatric primary care and the implementation strategies we use to implement it.

Reducing Excess Cardiovascular Risk in People with Serious Mental Illness

Project Name:
Reducing Excess Cardiovascular Risk in People with Serious Mental Illness
Principal Investigator:
Rebecca Rossom, MD, MS
Principal Investigator Contact Information:
Rebecca.C.Rossom@HealthPartners.com
Principal Investigator institution:
HealthPartners, Minneapolis, MN
Funder
NIMH
Funding Period:
08/2014 – 06/2019 
Abstract:
People with serious mental illness (SMI) (schizophrenia, schizoaffective disorder, bipolar disorder) die, on average, 20 years earlier than their peers. Cardiovascular (CV) disease is the predominant cause.  Primary care clinicians are often unaware of increased risk in patients with SMI and, even when they do identify elevated CV risk factors, often do not take appropriate clinical actions. Electronic health record-based clinical decision support can identify at-risk patients with SMI and systematically prompt more effective treatment of their CV risk factors, but its potential has been largely untapped. 
Grant Number:
U19MH092201
Participating Sites:
HealthPartners, Minneapolis, MN (Lead Site)
Essentia Health, Duluth, MN
Park Nicollet, Minneapolis, MN
Investigators:
Rebecca Rossom, MD, MS     
Steve Waring, PhD
Patrick O’Connor, MD, MS, MA
JoAnn Sperl-Hillen, MD
Lauren Crain, PhD
Kris Kopski, MD
Stephanie Hooker, PhD
Goals:
The objectives of this project were to improve CV risk factor care in patients with SMI through a pragmatic trial of a point-of-care electronic health record-based clinical decision support system (referred to as “CV Wizard”).  The trial was conducted in over 80 primary care clinics in three large healthcare systems.
Description of study sample:
Patients enrolled in the study were ages 18-75 with diagnoses of schizophrenia, schizoaffective disorder or bipolar disorder (i.e. serious mental illness (SMI)) and were not at goal for at least one of the following reversible cardiovascular risk factors: BMI, tobacco use, LDL, blood pressure, A1c or aspirin use.
Current Status:
The project was implemented in all 3 sites and completed patient enrollment in September 2018.   A total of 11,046 patients with SMI made at least one primary care visit during the study period, and 8937 patients made at least 2 primary care visits.
Study Registration:
ClinicalTrials.gov # NCT02451670
Publications:
Rossom RC, O’Connor PJ, Crain AL, Waring S, Ohnsorg K, Taran A, Kopski K, Sperl-Hillen JM. Pragmatic trial design of an intervention to reduce cardiovascular risk in people with serious mental illness. Contemp Clin Trials. 2020 Feb 20;91:105964. doi: 10.1016/j.cct.2020.105964. PubMed PMID: 32087336. Sperl-Hillen JM, Rossom RC, Kharbanda EO, Gold R, Geissal ED, Elliott TE, Desai JR, Rindal DB, Saman DM, Waring SC, Margolis KL, O’Connor PJ. Priorities Wizard: Multisite Web-Based Primary Care Clinical Decision Support Improved Chronic Care Outcomes with High Use Rates and High Clinician Satisfaction Rates. EGEMS (Wash DC). 2019 Apr 3;7(1):9. doi: 10.5334/egems.284. Review. PubMed PMID: 30972358; PubMed Central PMCID: PMC6450247.
Resources:
N/A
Lessons Learned:
N/A
What’s next?
Analyses and manuscript development are in progress.