Improving Suicide Risk Detection and Clinical Follow-up after Discharge from Nursing Homes

ABSTRACT

Objectives: Suicide Awareness for Veterans Exiting Community Living Centers (SAVE-CLC) is a brief intervention to standardize suicide-risk screening and clinical follow-up after VA nursing home discharge. This paper examines the outcomes of SAVE-CLC compared to care as usual.

Methods: A quasi-experimental evaluation was conducted (N = 124) with SAVE-CLC patients (n = 62) matched 1:1 to a pre-implementation comparison group. Data were obtained through VA Corporate Data Warehouse resources and chart reviews. Outcomes examined (within 30/90 days of discharge) included mortality rates, frequency of outpatient mental health visits, emergency department visits, rehospitalizations, depression screens (PHQ-2), and the latency period for outpatient mental health care.

Results: A greater portion of SAVE-CLC patients received a depression screen after discharge, n = 42, 67.7% versus n = 8, 12.9%, OR = 14.2 (5.7, 35.3), p < .001. The number of days between discharge and first mental health visit was also substantially shorter for SAVE-CLC patients, M = 8.9, SD = 8.2 versus M = 17.6, SD = 9.1; t = 2.47 (122), p = .02. Significant differences were not observed in emergency department visits, hospitalizations, or mortality.

Conclusions: SAVE-CLC is a time-limited intervention for detecting risk and speeding engagement in mental health care in the immediate high-risk post-discharge period.

Clinical Implications: Care transitions present an important opportunity for addressing older adults’ suicide risk; brief telephone-based interventions like SAVE-CLC may provide needed support to individuals returning home.

KEYWORDS:

• Care transitions
• nursing homes
• suicide risk

Acknowledgments

The authors wish to acknowledge Cathleen Kane, MS, John Klein, MS, for their assistance with data analysis and management and Dr. Lauren Hagemann for her contributions in the development of SAVE-CLC.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported through the Veterans Health Administration Innovators Network Spark-Seed-Spread program (FY17: Luci & Hilgeman, Co-PIs, and FY18: Luci, PI). Contributing authors were also supported by a) the Veterans Affairs Advanced Fellowship in Mental Illness Research and Treatment (EB); b) Veterans Affairs Rehabilitation Research & Development Career Development Award, RX001824-01A1 (MH); c) Veterans Affairs Rehabilitation Research & Development (IK2RX001824); d) VISN 2 Center of Excellence for Suicide Prevention; and e) with resources and support from the Boston VA Healthcare System where MLJ was employed at the time of the SAVE-CLC implementation. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.