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Risk Model-Guided Clinical Decision Support for Suicide Screening: A Randomized Clinical Trial.

Colin G Walsh1,2,3, Michael A Ripperger1, Laurie Novak1

  • 1Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.

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|January 3, 2025
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Summary
This summary is machine-generated.

Interruptive clinical decision support (CDS) significantly increased suicide risk assessments compared to noninterruptive CDS. This finding highlights the potential of targeted alerts in suicide prevention strategies.

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Area of Science:

  • Clinical Informatics
  • Psychiatry
  • Public Health

Background:

  • Effective suicide prevention necessitates robust risk identification, intervention, and follow-up protocols.
  • Current risk identification methods, including self-reporting and clinical screening, have limitations.
  • Statistical risk models offer potential but face integration challenges within clinical workflows, particularly concerning alert burden and clinical decision support (CDS) effectiveness.

Purpose of the Study:

  • To evaluate the effectiveness of risk model-driven clinical decision support (CDS) in prompting suicide risk assessments.
  • To compare interruptive versus noninterruptive CDS alert systems for suicide risk assessment.

Main Methods:

  • A comparative effectiveness randomized clinical trial involving 561 patients across neurology divisions at an academic medical center.
  • Patients were randomized to either interruptive or noninterruptive CDS systems designed to prompt further suicide risk assessment using a real-time, validated statistical suicide attempt risk model.
  • Suicide risk assessment documentation was manually reviewed to determine the main outcome (decision to assess risk in person) and secondary outcomes (rates of suicidal ideation and attempts).

Main Results:

  • Interruptive CDS resulted in significantly more decisions to screen for suicide risk (42%) compared to noninterruptive CDS (4%) and the prior year's baseline rate (8%).
  • The odds ratio for decisions to screen with interruptive CDS versus noninterruptive CDS was 17.70 (95% CI, 6.42-48.79; P < .001).
  • No documented episodes of suicidal ideation or attempts were observed in either treatment arm during the study period.

Conclusions:

  • Interruptive clinical decision support (CDS) significantly increases the rate of documented suicide risk assessments.
  • The findings support the use of interruptive CDS for prompting in-person suicide risk evaluations.
  • Further large-scale trials comparing interruptive CDS with standard care are recommended to assess its effectiveness in reducing suicidal self-harm.