Study aims to prevent suicide

Database to aid medical providers

A study that will incorporate centralized patient information is planned to identify the factors leading to suicide and to help prevent those unfortunate deaths.

The data will come from the state’s new health information exchange, called CTHealthLink, which will collect information gleaned from patients’ visits to their doctors, psychotherapists and hospital emergency departments. Until now, health care providers’ electronic medical records systems have not been able to communicate with each other.

Using that compiled information, the study, led by Robert H. Aseltine Jr., will help providers “better identify and treat patients at risk of suicide in the healthcare system. It bridges mental health, general health, hospitalbased care,” he said.

Aseltine, chairman of the Division of Behavioral Sciences and Community Health at UConn Health, is the principal investigator for the study, supported by a $1.9 million, three-year grant from the National Institute of Mental Health.

There is a pressing need for better information about who is at risk of suicide.

“Suicide is an urgent public health problem,” said Matthew Katz, CEO of the North Haven-based Connecticut State Medical Society, which sponsors CTHealthLink.

“It’s the 10th leading cause of death in the U.S. It’s the second-leading cause of death among youth,” he said. “Hospitalizations for suicide attempts in Connecticut have increased 15 percent between 2005 and 2015.”

He added that suicide attempts nationwide have gone up 24 percent in the last 10 years.

According to the state Chief Medical Examiner’s Office, suicides rose from 332 in Connecticut in 1990 to 387 in 2016. For those 10 to 19 years old, the totals were 24 in 1990 and 13 and 2016. However, the 10-19 range, after peaking at 27 in 1991, dropped in the years afterward.

“Somewhere between 85 percent and 90 percent of those who have died have seen a health-care professional in the past year,” Katz said, and “most of them have not been diagnosed or identified in any way. … We’re missing opportunities to catch and treat these individuals before they attempt suicide or before they die from suicide.”

CTHealthLink is a health information exchange, designed to give care providers all the pertinent information on each patient: “medical record data, all the psychological and medical clinical data, lab data, prescribing data,” Katz said.

Until now, that data has been stored in each providers’ computers or, at best, shared on an electronic medical record system, such as Epic, used by Yale New Haven Health and Hartford Healthcare, which includes MidState Medical Center in Meriden.

While the centralized information will help health care providers get a clearer picture of their patients’ health overall, it’s “a huge benefit because that robust data tells us a lot more about those who attempt suicide,” Katz said.

“The things that we can look for are whether they have conditions that may lead towards a propensity for suicide — depression that was not identified on a claim form, poor conditions, unemployment, (living) in an at-risk location, (being) homeless,” as well as drug use and whether the patient has seen a doctor recently, he said. “It helps track that information in a way that we’ve never seen before.”

“We’re not going to say that patient is at risk,” Katz said. “What we’re going to say is, you need to ask questions, you need to do some identifications to assess whether that patient is at risk.”

Identifying those at risk of suicide not only saves lives, he said, but reduces the cost to the health care system.

CTHealthLink will be especially helpful in identifying teenagers who show signs of depression or other symptoms that are associated with suicide attempts.

“It’s often harder to get information on teens because they’re not going to the doctor as often,” Katz said. “We’re not doing a good job today identifying teens at risk of suicide … They’re the ones we need. Where we need the most help in this country is identifying and treating youth who are at high risk for suicide.”

Determining treatment

The National Institute of Mental Health’s initiative is called Zero Suicide, Aseltine said. CTHealthLink will “collect all the information from all the different silos from which care is provided in the state of Connecticut,” he said.

“I’m using this infrastructure to create algorithms that will predict patient risk and to identify patients at risk of suicidal behaviors and to make that information available to their physicians so they can provide appropriate treatment.

“The same kind of models I’m using for suicide risk could be used to prevent rehospitalizations, to improve medication adherence and medication management, to prevent a recurrence of cardiac events,” Aseltine said.

“Mostly when you have those major crisis events there’s medical care involved and those events will show up,” said Dr. Steven Thornquist, president of the Connecticut State Medical Society. “This allows us to get more eyes on the warning signs.

“We have through … the health information exchange access to a fairly detailed database of patient interactions, which consist of doctor visits, labs, ER visits,” he said. “That individual’s activity can be tracked through time and through space. You can look at it and tease out things that you can’t do without doing a long-term, large-population study. … The way this becomes a way to prevent suicide is we have a log of all these encounters.”

CTHealthLink was created in the fall of 2017, based on the successful system used in Kansas, according to Dr. Claudia Gruss of Wilton, president-elect of the Connecticut Medical Society and chairwoman of its Quality of Care Committee. It is a member of the KaMMCO Health Solutions Network.

“I think there are several ways that this can be extremely helpful,” said Gruss. A primary care physician can “do screening for depression at the time that the patient comes in, at least on a yearly basis.”

That screening “was included in the regulations for Obamacare for practice measures and meaningful use,” she said.

“Obviously if it’s abnormal then we can take it a step further and either we discuss with the patient about depression and suicide prevention or we can set up a referral to a healthcare professional who specializes in psychiatry or psychological social work or somebody who deals with treating depression either cognitively or through medication,” Gruss said.

Aseltine said, “The conditions that lead to [suicide] are typically very treatable if we can get appropriate care to those who are vulnerable. It includes a number of different therapies, including medication, including cognitive behavioral therapy, and those have proven to be quite effective in helping people manage their problems and to address the underlying mental health issues associated with suicidal behavior.”

Protecting privacy

The advantage of CTHealthLink is that “even if the two professionals have different (electronic medical record systems) or even if one doesn’t have an EMR they can have access to the medical record if they’re tied into the clearinghouse,” Gruss said.

There are a number of vendors of electronic medical records: Epic, Cerner, Allscripts, NextGen Healthcare and Greenway Health. “Even if you’re on Epic with one medical group and Epic with another medical group, the two Epics don’t talk to each other,” Gruss said. CTHealthLink solves that problem.

It will be compliant with federal privacy laws as well. Only the patients and their doctors can access the information, Gruss said. “There are many safeguards built into the system to protect the patients’ medical records,” she said.

“I’m very excited about this project,” Gruss said. “I think it can markedly improve medical care. … Right now, if you’re in a different medical group, you don’t share information unless it’s sent by fax or snail mail or telephone calls, but even then you get only part of the medical information,” Gruss said. “Obviously, things can get lost in the sauce.”

Among the advantages of the exchange is that doctors can look for negative drug interactions. “It also lets us keep track of appointments and whether they’re showing up for appointments,” Gruss said. Another clue is whether patients are “renewing their medications at an appropriate time and thus are they taking it,” she said.

Health care providers will have to join the exchange voluntarily and there will be a cost, but there is also an advantage in that.

Katz said they expect to have some results of the study within 18 months, but the study will last three years. “We have to sign up a provider at a time,” he said, and there will be a cost, the data will help providers file required reports with the Centers for Medicare and Medicaid Services.

Besides physicians, social workers, psychologists and dentists will be encouraged to join the exchange.

“There are people who have some models for how to predict suicide risk, but this will allow us to put that to the test,” Thornquist said.