TY  - JOUR
AU  - Haroz, Emily E
AU  - Grubin, Fiona
AU  - Goklish, Novalene
AU  - Pioche, Shardai
AU  - Cwik, Mary
AU  - Barlow, Allison
AU  - Waugh, Emma
AU  - Usher, Jason
AU  - Lenert, Matthew C
AU  - Walsh, Colin G
PY  - 2021
DA  - 2021/9/2
TI  - Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers
JO  - JMIR Public Health Surveill
SP  - e24377
VL  - 7
IS  - 9
KW  - suicide prevention
KW  - machine learning
KW  - Native American health
KW  - implementation
AB  - Background: Machine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied. Objective: This study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations. Methods: Participants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways. Results: Case managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers’ clinical judgment would help increase sensitivity. Conclusions: Suicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting. 
SN  - 2369-2960
UR  - https://publichealth.jmir.org/2021/9/e24377
UR  - https://doi.org/10.2196/24377
UR  - http://www.ncbi.nlm.nih.gov/pubmed/34473065
DO  - 10.2196/24377
ID  - info:doi/10.2196/24377
ER  -