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

The 3 rd 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. 90% Any Visit Any MH 80% Percent Receiving Services IP MH 70% IP CD 60% IP Other ED MH 50% ED CD 40% ED Other 30% PC MH PC CD 20% PC Other 10% OP MH OP Other 0% 52 49 46 43 40 37 34 31 28 25 22 19 16 13 10 7 4 1 OP CD Weeks Prior to Suicide Death

Risk Is Not Limited to Mental Health Adjusted Odds Ratio (age, sex; Case *indicates also significant after Control (n=267400) (n=2674) adjustment for psych diagnoses). Condition % (n) % (n) aOR CI p-value 5.6 (15021) 6.2 (166) Asthma 1.30 1.11, 1.52 <0.001 11.5 (30669) 22.6 (603) Back Pain 1.97 1.79, 2.16 <0.001* 0.5 (1210) 6.4 (120) Brain Injury 14.95 12.60, 17.73 <0.001* 3.3 (8883) 8.7 (232) Cancer 1.59 1.38, 1.83 <0.001* 1.3 (3463) 4.4 (118) CHF 1.78 1.45, 2.19 <0.001* 4.0 (10657) 10.1 (269) COPD 2.04 1.79, 2.33 <0.001* 6.1 (16380) 11.6 (311) Diabetes 1.18 1.04, 1.34 0.008 0.4 (1111) 1.4 (38) Epilepsy 3.27 2.35, 4.54 <0.001* 0.1 (380) 0.8 (21) HIV/AIDS 3.39 2.17, 5.27 <0.001* 3.2 (8643) 8.3 (221) Heart disease 1.19 1.02, 1.37 0.023 15.4 (41162) 27.8 (742) Hypertension 1.37 1.24, 1.52 <0.001 1.9 (5174) 3.5 (94) Migraine 2.82 2.29, 3.49 <0.001* 0.2 (611) 0.4 (10) Multiple sclerosis 1.85 0.99, 3.48 0.055 1.5 (3941) 1.8 (48) Osteoporosis 1.21 0.90, 1.62 0.216 0.2 (507) 0.8 (21) Parkinson's 1.87 1.20, 2.91 0.006 0.5 (1288) 1.1 (30) Psychogenic pain 3.20 2.21, 4.62 <0.001 2.3 (6255) 6.4 (172) Renal disorder 1.48 1.26, 1.74 <0.001 4.6 (12334) 18.5 (495) Sleep disorders 3.66 3.30, 4.05 <0.001* 0.9 (2372) 3.3 (88) Stroke 1.97 1.58, 2.47 <0.001

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 • 75-80% reduction in suicide rate for HFHS. • Preliminary data show similar patters at other systems. 120.0 Baseline Perfect Depression Care / Zero Suicide Model 100.0 80.0 Rate per 100,000 Persons 60.0 40.0 20.0 0.0 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

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 Emotion Regulation Usual Care Risk Assessment / Skills Training 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?