Challenges of Population-based Measurement of Suicide Prevention Activities Across Multiple Health Systems

Abstract

Suicide is a preventable public health problem. Zero Suicide (ZS) is a suicide prevention framework currently being evaluated by Mental Health Research Network investigators embedded in six Health Care Systems Research Network (HCSRN) member health systems implementing ZS. This paper describes ongoing collaboration to develop population-based process improvement metrics for use in, and comparison across, these and other health systems. Robust process improvement metrics are sorely needed by the hundreds of health systems across the country preparing to implement their own best practices in suicide care. Here we articulate three examples of challenges in using health system data to assess suicide prevention activities, each in ascending order of complexity: 1) Mapping and reconciling different versions of suicide risk assessment instruments across health systems; 2) Deciding what should count as adequate suicide prevention follow-up care and how to count it in different health systems with different care processes; and 3) Trying to determine whether a safety planning discussion took place between a clinician and a patient, and if so, what actually happened. To develop broadly applicable metrics, we have advocated for standardization of care processes and their documentation, encouraged standardized screening tools and urged they be recorded as discrete electronic health record (EHR) variables, and engaged with our clinical partners and health system data architects to identify all relevant care processes and the ways they are recorded in the EHR so we are not systematically missing important data. Serving as embedded research partners in our local ZS implementation teams has facilitated this work.

Keywords: electronic health record; health systems; population-based; suicide prevention; zero suicide.

Conflict of interest statement

The authors received grant funding from the National Institute of Mental Health (grant number MH114087) to conduct an evaluation of the implementation of Zero Suicide across six health care systems. MS is Senior Advisor for Mental Health Services, Epidemiology, and Economics, Division of Services and Intervention Research, National Institute of Mental Health. BY, BA, AB, JB, KC, and GS have received additional funding from the National Institutes of Health for research related to this topic. BY and KC have also received honoraria for grant review from the National Institutes of Health (not related to this topic but in general). JGG is Director of the Zero Suicide Institute which receives payment for consultation and training in the Zero Suicide model; she is also the co-PI or Subject Matter Expert/Consultant on multiple grants on suicide prevention and Zero Suicide.