Implementing Machine Learning Models for Suicide Risk Prediction in Clinical Practice: Focus Group Study With Hospital Providers.

Autor:	Bentley KH; Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.; Department of Psychology, Harvard University, Cambridge, MA, United States.; Harvard Medical School, Boston, MA, United States., Zuromski KL; Department of Psychology, Harvard University, Cambridge, MA, United States., Fortgang RG; Department of Psychology, Harvard University, Cambridge, MA, United States., Madsen EM; Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States., Kessler D; Department of Psychology, Harvard University, Cambridge, MA, United States., Lee H; Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States., Nock MK; Department of Psychology, Harvard University, Cambridge, MA, United States., Reis BY; Harvard Medical School, Boston, MA, United States.; Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States., Castro VM; Research Information Science and Computing, Mass General Brigham, Somerville, MA, United States., Smoller JW; Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.; Harvard Medical School, Boston, MA, United States.; Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States.
Jazyk:	angličtina
Zdroj:	JMIR formative research [JMIR Form Res] 2022 Mar 11; Vol. 6 (3), pp. e30946. Date of Electronic Publication: 2022 Mar 11.
DOI:	10.2196/30946
Abstrakt:	Background: Interest in developing machine learning models that use electronic health record data to predict patients' risk of suicidal behavior has recently proliferated. However, whether and how such models might be implemented and useful in clinical practice remain unknown. To ultimately make automated suicide risk-prediction models useful in practice, and thus better prevent patient suicides, it is critical to partner with key stakeholders, including the frontline providers who will be using such tools, at each stage of the implementation process. Objective: The aim of this focus group study is to inform ongoing and future efforts to deploy suicide risk-prediction models in clinical practice. The specific goals are to better understand hospital providers' current practices for assessing and managing suicide risk; determine providers' perspectives on using automated suicide risk-prediction models in practice; and identify barriers, facilitators, recommendations, and factors to consider. Methods: We conducted 10 two-hour focus groups with a total of 40 providers from psychiatry, internal medicine and primary care, emergency medicine, and obstetrics and gynecology departments within an urban academic medical center. Audio recordings of open-ended group discussions were transcribed and coded for relevant and recurrent themes by 2 independent study staff members. All coded text was reviewed and discrepancies were resolved in consensus meetings with doctoral-level staff. Results: Although most providers reported using standardized suicide risk assessment tools in their clinical practices, existing tools were commonly described as unhelpful and providers indicated dissatisfaction with current suicide risk assessment methods. Overall, providers' general attitudes toward the practical use of automated suicide risk-prediction models and corresponding clinical decision support tools were positive. Providers were especially interested in the potential to identify high-risk patients who might be missed by traditional screening methods. Some expressed skepticism about the potential usefulness of these models in routine care; specific barriers included concerns about liability, alert fatigue, and increased demand on the health care system. Key facilitators included presenting specific patient-level features contributing to risk scores, emphasizing changes in risk over time, and developing systematic clinical workflows and provider training. Participants also recommended considering risk-prediction windows, timing of alerts, who will have access to model predictions, and variability across treatment settings. Conclusions: Providers were dissatisfied with current suicide risk assessment methods and were open to the use of a machine learning-based risk-prediction system to inform clinical decision-making. They also raised multiple concerns about potential barriers to the usefulness of this approach and suggested several possible facilitators. Future efforts in this area will benefit from incorporating systematic qualitative feedback from providers, patients, administrators, and payers on the use of these new approaches in routine care, especially given the complex, sensitive, and unfortunately still stigmatized nature of suicide risk. (©Kate H Bentley, Kelly L Zuromski, Rebecca G Fortgang, Emily M Madsen, Daniel Kessler, Hyunjoon Lee, Matthew K Nock, Ben Y Reis, Victor M Castro, Jordan W Smoller. Originally published in JMIR Formative Research (https://formative.jmir.org), 11.03.2022.)
Databáze:	MEDLINE
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