Research & Evaluation Brian K. Ahmedani, PhD Director of - - PowerPoint PPT Presentation

The 3rd International Summit of Zero Suicide in Healthcare

Sydney, Australia

Research & Evaluation

Brian K. Ahmedani, PhD Director of Psychiatry Research Henry Ford Health System

Suicide Rates Across the World

Suicide and Healthcare Settings

• Most people make a healthcare visit before suicide.
• Greatest risk for suicide is following psychiatric hospitalization (other research).
• Greatest # of suicides occur among general medical patients.
• Less than 50% of patients have MH diagnosis before suicide.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Weeks Prior to Suicide Death Percent Receiving Services

Any Visit Any MH IP MH IP CD IP Other ED MH ED CD ED Other PC MH PC CD PC Other OP MH OP Other OP CD

Control (n=267400) Case (n=2674) Adjusted Odds Ratio (age, sex; *indicates also significant after adjustment for psych diagnoses). Condition % (n) % (n) aOR CI p-value Asthma 5.6 (15021) 6.2 (166) 1.30 1.11, 1.52 <0.001 Back Pain 11.5 (30669) 22.6 (603) 1.97 1.79, 2.16 <0.001* Brain Injury 0.5 (1210) 6.4 (120) 14.95 12.60, 17.73 <0.001* Cancer 3.3 (8883) 8.7 (232) 1.59 1.38, 1.83 <0.001* CHF 1.3 (3463) 4.4 (118) 1.78 1.45, 2.19 <0.001* COPD 4.0 (10657) 10.1 (269) 2.04 1.79, 2.33 <0.001* Diabetes 6.1 (16380) 11.6 (311) 1.18 1.04, 1.34 0.008 Epilepsy 0.4 (1111) 1.4 (38) 3.27 2.35, 4.54 <0.001* HIV/AIDS 0.1 (380) 0.8 (21) 3.39 2.17, 5.27 <0.001* Heart disease 3.2 (8643) 8.3 (221) 1.19 1.02, 1.37 0.023 Hypertension 15.4 (41162) 27.8 (742) 1.37 1.24, 1.52 <0.001 Migraine 1.9 (5174) 3.5 (94) 2.82 2.29, 3.49 <0.001* Multiple sclerosis 0.2 (611) 0.4 (10) 1.85 0.99, 3.48 0.055 Osteoporosis 1.5 (3941) 1.8 (48) 1.21 0.90, 1.62 0.216 Parkinson's 0.2 (507) 0.8 (21) 1.87 1.20, 2.91 0.006 Psychogenic pain 0.5 (1288) 1.1 (30) 3.20 2.21, 4.62 <0.001 Renal disorder 2.3 (6255) 6.4 (172) 1.48 1.26, 1.74 <0.001 Sleep disorders 4.6 (12334) 18.5 (495) 3.66 3.30, 4.05 <0.001* Stroke 0.9 (2372) 3.3 (88) 1.97 1.58, 2.47 <0.001

Risk Is Not Limited to Mental Health

The Henry Ford Story

• Institute of Medicine Report: “Crossing the Quality Chasm”
• RWJ Grant Opportunity Finalist

– Application for ‘Perfect Depression Care’ in Behavioral Health Services Department at HFHS

• “Blues Busters” Team (Led by Dr. Ed Coffey)

– Zero Suicides becomes the goal; Expanded to all conditions (not just depression)

• 75-80% suicide rate reduction in BHS

– Zero Suicides in 2009 for all BHS Patients – Stable suicide rate for ‘all Health System Patients despite a ~30% increase statewide

• Increased gross contribution (total net revenue minus total direct expenses)

– 8-fold improvement in the first 3 years after implementation

• Expansion into Primary Care in 2010

Outcomes from Henry Ford

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 State of Michigan† 94.6 82.9 41.1 0.0 18.5 9.8 20.4 40.3 22.5 12.8 0.0 Internal* 110.3 82.9 41.1 9.9 27.7 0.0 20.4 40.3 11.2 0.0 0.0 Combined‡ 110.3 82.9 41.1 9.9 36.9 9.8 20.4 40.3 22.5 12.8 0.0 SoM Population║ 9.8 9.8 10.4 10.9 10.0 10.7 10.8 11.0 10.9 11.6 11.4 Matched§ 94.6 82.9 41.1 0.0 9.2 0.0 20.4 40.3 11.2 0.0 0.0 0.0 20.0 40.0 60.0 80.0 100.0 120.0 Rate per 100,000 Persons

Baseline Perfect Depression Care / Zero Suicide Model

• 75-80% reduction in suicide rate for HFHS.
• Preliminary data show similar patters at other systems.

Ongoing Evaluation

• Needs Assessment
• Tracking Fidelity to the Implemented Model
• Tracking Outcomes
• Informing Decisions about Ongoing Quality Improvement
• Root-Cause Analysis

New Research

• Pragmatic trial of population-based programs to prevent

suicide attempt (PI: Greg Simon).

– Largest trial to date (>18,000 participants).

Outpatients responding “more than half the days” or “nearly every day” to PHQ item 9 Usual Care Emotion Regulation Skills Training Risk Assessment / Care Management

Other Proposed Research & Evaluation

• Evaluating ZS Implementation across multiple large health

systems in the US (through MHRN and other systems).

• Ongoing research and evaluation of numerous suicide-specific

treatments/interventions (ongoing trials).

• Development of EHR-based algorithms to detect suicide risk

(VA, MHRN, and others).

• Evaluation of screening and assessment measures.
• Learning from ZS Implementation across hundreds of health

systems in the US and around the world (that’s up to all of us).

Questions?