Did you know that September is recognized as Suicide Prevention Awareness Month? This topic is personal to me as I have lost classmates and family friends to suicide, and though I knew there was no one to blame, it didn’t stop the thoughts of “If I had just…” from flooding my mind each time. An estimated 1.6 million suicide attempts were reported in 2022, and many of you reading may resonate with similar experiences, which is why I would like to take the opportunity to discuss the tools available in Azara DRVS for identifying patients who may be at a higher risk for suicide—with the hope that implementing these tools might minimize the number of instances of “If I had just…” among providers, family members, and friends.
From 2020 to 2021, suicide rates increased 36%, making it the 12th leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), suicide rate rose again, by an additional 3% from 2021 to 2022, positioning it as the 11th leading cause of death in the country. In 2022, suicide led to the loss of 49,449 lives, which equates to an average of 136 individuals each day. With suicide rates reaching record highs, let’s explore the tools available in DRVS to enhance the ability to monitor at-risk patients.
Last year, we discussed how to use Cohorts in DRVS to identify individuals at high risk. This year, I would like to highlight using Registries and Alerts to effectively help identify these patients.
Registries
Registries in DRVS allow you to create custom reports to track specific initiatives for your center’s patients. The ability to customize inclusion criteria provides many options for how to visualize the data that is already in your EHR. To help with tracking screenings, including suicide risk assessments and follow-up, use our registry data elements (RDEs) including:
Suicide Risk Assessment – Structured data questions or completed form with an indication of suicide risk (high, med, low), Columbia Suicide Severity Scale Assessment
Suicide Attempt Intentional Self-Harm – ICD10 and SNOMED codes
Suicidal Ideations – (R45.851)
BH Interaction – Record of a face to face interaction with a behavioral health service provider that is not captured in any other way, such as by service line or charge codes
PHQ 9 Depression screening – Score of completed PHQ9 Depression Screening
PHQ-9 Question 9 – Score of PHQ9 Question 9 - thoughts that you would be better off dead, or of hurting yourself in some way
Depression Diagnosis – ICD10 and SNOMED codes
These are just a few observations that use diagnosis and other structured data from your EHR which can be used to bring all this information together in a custom Registry. If you have any questions on whether these structed data points are mapped in DRVS for your practice, please open a ticket with Support. If you’re new to creating registries our Registries User Guide available in the DRVS Help section is a great place to start!
Pictured above is an example of a custom Registry, leveraging some of the Registry Data Elements using Suicide Risk Assessment and Depression Screenings, diagnoses in DRVS.
Alerts
Alerts are found in Azara DRVS on both the Patient Visit Planning (PVP) report and the Care Management Passport (CMP) and are used to remind providers of patient care needed at the point of care.
Some alerts available in DRVS that will trigger for patients pertaining to depression screening and suicide risk include:
Suicide Risk - Ages 10-17: Patients aged 10-17 who have not had a suicide risk assessment performed in the last 6 months.
Suicide Risk - Ages 18+: Patients aged 18 and older who have not had a suicide risk assessment performed in the last 12 months.
MDD Suicide Risk Assessment: Alert will trigger if Suicide Risk Assessment has not occurred in the last 0 days. Alert only applies to patients >= 6 yrs old and <= 17 yrs old. Patient must have a Major Depressive Disorder.
Depression Screen: Alert will trigger if Standardized Depression Screen has not occurred in the last year. Alert only applies to patients >= 12 yrs old. Patient must not have Depression Screen Refused or Depression Screen Contraindicated or Bipolar Disorder First Dx.
PHQ-9: Alert will trigger if PHQ-9 Depression Screen has not occurred in the last year. Alert only applies to patients >= 12 yrs old. Patient must not have Depression or Bipolar Dx.
Depression Screen w/Dx: Alert will trigger if Standardized Depression Screen has not occurred in the last year. Alert only applies to patients >= 12 yrs old. Patient must have Bipolar Disorder First Dx or Depression. Patient must not have Postpartum Depression or Major Depressive Disorder in Remission or Depression Screen Refused or Depression Screen Contraindicated.
Depression Follow-Up: Alert will trigger if patient had positive depression screen results AND had no depression follow-up performed on the same day of the screening or up to 2 days after screening. Patient must not have Bipolar Disorder First Dx, Depression Screen Contraindicated, or Depression Screen Refused.
Alerts in Action
To find these and more related alerts you can navigate to the Alert Administration in DRVS, shown below. Toggle to “All” to see a complete list of available alerts and use the search bar to narrow your selection. You can find more information on configuring alerts in our help section.
I hope this has provided some valuable insight into how you can use the data already available in DRVS to help monitor patients at high risk of suicide. If you have questions, please reach out to support at support@azarahealthcare.com
Links to resources mentioned above:
Suicide Prevention Awareness Month–Using DRVS to Identify High-Risk Patients: https://www.azarahealthcare.com/blog/suicide-prevention-awareness-month-using-drvs-to-identify-high-risk-patients
Registries User Guide: https://drvshelp.azarahealthcare.com/registries
Configuring Alerts: https://drvshelp.azarahealthcare.com/configuringalerts
Sources:
American Foundation for Suicide Prevention, Suicide Statistics
https://afsp.org/suicide-statistics/
Provisional Estimates of Suicide by Demographic Characteristics: United States, 2022 https://www.cdc.gov/nchs/data/vsrr/vsrr034.pdf
National Alliance on Mental Illness, Suicide Prevention Awareness Month (SPAM)
https://www.nami.org/get-involved/awareness-events/suicide-prevention-month/
