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.