Quality Measures to Advance Suicide Prevention and Care Across Health Systems

PROJECT SUMMARY / ABSTRACT Suicide accounted for >48,000 deaths in the United States (US) in 2021. The annual rate has increased by >34% in the last 20 years. Suicide prevention is a top NIMH research priority. Evidence suggests that suicide attempts (fatal and non-fatal) are preventable, and health systems are an optimal location to implement prevention approaches. Research conducted by the Mental Health Research Network (MHRN) and others demonstrates that there are effective tools for suicide risk screening, risk assessment, safety planning and follow-up care and the workflows and resources needed for implementation are feasible. In the US, these approaches have been introduced in healthcare systems as part of a suicide prevention care pathway called the Zero Suicide (ZS) Model. Now an international movement, the ZS Model has been introduced in >20 countries worldwide and 100s of health systems in the US. As health systems continue to implement the ZS Model, it is necessary to develop adequate quality measures to facilitate rapid cycle quality improvement and benchmarking with the goal to improve suicide prevention care and reduce suicide. While initial quality measures have been developed by national accreditation and quality organizations, there remain opportunities for significant improvement. This study fills these major gaps through a series of three Specific Aims, including 1) To develop and test a set of suicide ideation and attempt (fatal and non-fatal) outcome measures, 2) To develop and test suicide care process measures to determine their impact on outcomes, including measures for suicide risk screening, risk assessment, safety planning, and specialty follow up care, and 3) To disseminate and optimize these measures via consensus meetings with the National Committee for Quality Assurance (NCQA), The Joint Commission (TJC), other professional organizations, and patient and health system stakeholders. This study leverages electronic health record and insurance claims data from 3 large geographically and demographically diverse health systems affiliated with the MHRN located in Washington, Colorado, and Michigan. It also builds upon initial metrics developed through completed work evaluating ZS Model Implementation across these participating health systems. In total, these systems serve more than 2 million unique patients per year aged 10 years and older across clinical settings. Available data include suicide attempt and death records, patient reported suicide screening, clinical suicide risk assessment, safety plans, diagnoses, procedures, treatments, and encounter types from 2016 through 2023. These data will be used to develop and test a range of quality measures aligned with the aims in partnership with stakeholders from NCQA and TJC to support rapid dissemination and adoption.