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2019 HSR&D/QUERI National Conference Abstract

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4095 — VA Suicide Risk Identification Strategy: Preliminary Findings and Implementation Strategies in VA Ambulatory Care Settings

Lead/Presenter: Nazanin Bahraini,  Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)
All Authors: Bahraini NH (Rocky Mountain MIRECC), Matarazzo BB (Rocky Mountain MIRECC), Post EP (VA Central Office, Office of Primary Care Services) Barry CN (Program Evaluation and Resource Center) Brenner LA (Rocky Mountain MIRECC)

Objectives:
In October 2018, the Veterans Health Administration (VHA) implemented the VA Suicide Risk Identification Strategy (VA Risk ID), the largest population-based screening and evaluation strategy in any U.S. healthcare system. A key focus of this strategy is identifying suicide risk among the cohort of patients who are eligible for annual mental health screening. This cohort comprises approximately 76.2% of all Veterans receiving VHA care and represents an important opportunity to identify Veterans with unrecognized risk that may present to a wide range of ambulatory care settings, including primary care. We will provide an overview of VA Risk ID, report preliminary findings on implementation of VA Risk ID in ambulatory care settings, and discuss strategies used to facilitate implementation in these settings.

Methods:
VA Risk ID uses high quality, evidence-based tools to identify actionable suicide risk. Once risk is identified, providers gather information to form clinical impressions of risk (i.e., levels of acute and chronic risk), which informs the development of a risk management plan. This process occurs over three stages: primary screening to identify those who might be at risk, secondary screening to improve specificity and a Comprehensive Suicide Risk Evaluation (CSRE).

Results:
To date, 1,573,063 Veterans have received the primary screen in ambulatory care settings. Associated ideation prevalence is 3.18% (n = 50,093). The secondary suicide risk screen is positive 17.02% of the time (n = 6,073). We will report data on the number of Veterans in ambulatory care settings who progress on to the CSRE and describe the risk mitigation strategies utilized by providers for different levels of acute and chronic risk. We will also discuss the implementation strategies (e.g., technical assistance) utilized to facilitate implementation in ambulatory care settings.

Implications:
Initial data highlights the feasibility of routine suicide screening and evaluation in ambulatory care settings. The associated prevalence of suicidal ideation in these settings underscores the importance of systematically implementing suicide risk screening and evaluation in non-mental health settings.

Impacts:
VA Risk ID is a critical first step towards a unified strategy to improve the detection and management of suicide risk among all Veterans presenting to VHA care.