Division of Research–led study will evaluate multiple strategies to reach patients struggling with suicidal thoughts
Kaiser Permanente researchers and clinical partners have received a $12 million, 5-year award from the Patient-Centered Outcomes Research Institute (PCORI) to evaluate strategies to overcome common challenges patients face when struggling with suicide risk. This project will evaluate suicide prevention care processes for more than 300,000 Kaiser Permanente Northern California (KPNC) patients who interact with mental health services each year.
The project is being led by Esti Iturralde, PhD, a research scientist with the Kaiser Permanente Division of Research.
To carry out a large-scale project with many thousands of patients, Iturralde is working with leaders in psychiatry at KPNC and The Permanente Medical Group (TPMG): Honor Hsin, MD, Associate Chair of Mental Health Access and Operations, and Lisa Fazzolari, DO, Associate Chair of Mental Health Quality and Regional Depression Care Management Lead.
“This award recognizes KPNC’s commitment to suicide prevention and underscores our strength as an integrated care delivery system — one that unites clinical practice with groundbreaking research around a shared, patient-centered mission,” said Hsin.
“It enables us to evaluate the impact of solutions as we build them with the members we serve, enhancing a model of care that is rooted in clinical evidence, lived experience, and shared purpose,” Hsin added.
Kaiser Permanente delivers evidence-based assessments and treatments to address suicide risk, as part of a nationally recognized framework known as Zero Suicide. This approach spans a continuum of screening, brief interventions, and follow-up care, tailored to patients’ individual needs.
But there remain questions such as: What are the best ways to engage patients in brief interventions such as safety planning, which helps for understanding warning signs and taking steps to avoid self-harm and seek help? “Also, how do we accurately recognize high risk among the large number of patients seeking care and how do we help such patients engage with treatment?” Iturralde noted.
This award recognizes KPNC’s commitment to suicide prevention and underscores our strength as an integrated care delivery system.
— Honor Hsin, MD
The project will systematically evaluate care strategies that are gradually rolled out system-wide with the goal of learning which strategies should be adopted and which discarded. For example, the project will evaluate clinician supports and electronic tools intended to make it easier for patients to complete safety planning. The project also will study different methods for communicating with the care team between mental health visits. Study data will include comprehensive feedback from patients and clinicians who experience these care strategies.
“One question we have is whether the best approach is to facilitate more in-the-moment interventions during regular outpatient care, or whether it makes sense to add an additional safety net of specialized providers who step in to help through phone or video interactions,” Iturralde explained. “We want to know which approach helps patients benefit the most from recommended suicide prevention practices.”
The outcomes to be tracked include rates of safety planning, patient engagement with outpatient care, and reduction in suicide attempts.
“Patients are engaged in an individualized suicide care management plan through specific steps and evidence-based interventions,” Fazzolari said. “Providers create an environment where patients feel heard and supported. This collaborative and patient-centered approach instills hope, enhances safety, and maintains commitment to treatment and recovery.”
PCORI support
PCORI is a nonprofit organization with a mission to fund research designed to provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed health care decisions.
“This research study was selected for PCORI funding for its potential to provide real-world evidence on the comparative clinical effectiveness of different approaches to prevent suicide among people receiving mental health care,” said PCORI Executive Director Nakela L. Cook, MD, MPH. “By addressing a key evidence gap in suicide prevention, this study has the potential to improve patient care and outcomes. We look forward to following its progress.”
Along with measuring patient outcomes, the investigators will carry out surveys and interviews with patients and staff at KPNC, and gather input from patient, clinician, and health system advisors locally and from across the US. Advisors include suicide prevention researchers from Henry Ford Health in Michigan, a nationally recognized pioneer of the Zero Suicide framework, and investigators from Kaiser Permanente’s Southern California and Washington regions, and from the HealthPartners health care system in Minnesota. The study team will also collaborate with the Now Matters Now suicide prevention organization.
The project is the natural next step in ensuring KPNC mental health care is both caring and evidence-based, said Maria T. Koshy, MD, TPMG director of regional mental health administration. “Suicide is a major public health concern whose impact on our communities is beyond measurement,” Koshy said. “We need to know the most effective ways to identify those at risk and provide evidence-based interventions that work. This kind of research is the best way to do that, and we are proud of the confidence PCORI has placed in our teams to answer this question.”
Iturralde said it was exciting to be supported by PCORI, a nationally known funder of research that has pioneered engagement with community partners. “PCORI is dedicated to promoting rigorous and partner-engaged methods to answer meaningful questions in clinical effectiveness research,” she said. “They fill an important need in the health research landscape.”
The funding award has been approved pending completion of PCORI’s business and programmatic review and issuance of a formal award contract.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org or follow us @KPDOR
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