PDF(Pubmed)
Abstract：
UNASSIGNED: Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month.
UNASSIGNED: We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization.
UNASSIGNED: Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities.
UNASSIGNED: In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.
UNASSIGNED: We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization.
UNASSIGNED: Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities.
UNASSIGNED: In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.
摘要：
■在初级保健机构中普遍筛查自杀风险是预防自我伤害和改善健康结果的有希望的途径。将青少年分类到适当的护理水平，包括从急诊科(ED)转移低风险患者是一个有意义的目标.先前的研究表明，综合行为健康（IBH）可以防止在自杀风险筛查当天不必要地进入ED。我们假设，在自杀风险筛查当天接受IBH咨询的年轻人不太可能进入ED，但更有可能在下个月联系IBH服务并利用初级保健。
我们对3,649名年龄在10-18岁的青少年进行了回顾性图表回顾，他们在两个儿科初级保健实践中接受了“询问自杀筛查问题”(ASQ)筛查。我们收集了人口统计数据,ASQ和患者健康问卷-9(PHQ-9)评分，以及与IBH的患者接触，ED,以及筛查当天和随后31天的医疗初级保健。我们进行了一系列逻辑回归和卡方分析，以确定在积极的自杀风险筛查当天与IBH接触是否可以预测当天进入ED。IBH联系人,和医疗初级保健利用。
■在7,982个ASQ分数中，1,380（18％）是非急性的，87个ASQ（1％）筛查为急性阳性。无论是否与IBH接触，超过90％的阳性筛选都从ED转移。没有一个病人死于自杀。对于所有阳性筛查（急性和非急性一起），当天IBH与一般ED就诊的可能性更高相关。在与筛查同一天接受IBH咨询的阳性筛查均未在随后的一个月进入ED。与IBH接触的同一天，筛查积极预测下一个月IBH和医疗初级保健服务的利用率，特别是对于具有少数种族和族裔身份的年轻人。
■在具有IBH和系统风险评估流程的诊所中，大多数筛查自杀风险呈阳性的年轻人都被从ED转移。然而,与我们的假设相反,我们的研究表明,与未接受IBH会诊的同龄人相比,接受当日IBH会诊的青少年更有可能被纳入ED.这些结果表明，在儿科初级保健中进行系统的自杀筛查与IBH咨询相结合，可以有效地确定风险水平并将患者分诊到适当的护理中。
我们对3,649名年龄在10-18岁的青少年进行了回顾性图表回顾，他们在两个儿科初级保健实践中接受了“询问自杀筛查问题”(ASQ)筛查。我们收集了人口统计数据,ASQ和患者健康问卷-9(PHQ-9)评分，以及与IBH的患者接触，ED,以及筛查当天和随后31天的医疗初级保健。我们进行了一系列逻辑回归和卡方分析，以确定在积极的自杀风险筛查当天与IBH接触是否可以预测当天进入ED。IBH联系人,和医疗初级保健利用。
■在7,982个ASQ分数中，1,380（18％）是非急性的，87个ASQ（1％）筛查为急性阳性。无论是否与IBH接触，超过90％的阳性筛选都从ED转移。没有一个病人死于自杀。对于所有阳性筛查（急性和非急性一起），当天IBH与一般ED就诊的可能性更高相关。在与筛查同一天接受IBH咨询的阳性筛查均未在随后的一个月进入ED。与IBH接触的同一天，筛查积极预测下一个月IBH和医疗初级保健服务的利用率，特别是对于具有少数种族和族裔身份的年轻人。
■在具有IBH和系统风险评估流程的诊所中，大多数筛查自杀风险呈阳性的年轻人都被从ED转移。然而,与我们的假设相反,我们的研究表明,与未接受IBH会诊的同龄人相比,接受当日IBH会诊的青少年更有可能被纳入ED.这些结果表明，在儿科初级保健中进行系统的自杀筛查与IBH咨询相结合，可以有效地确定风险水平并将患者分诊到适当的护理中。
