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Boggs JM, Richards J, Simon G, Aguirre-Miyamoto EM, Barton LJ, Beck A, Beidas RS, Bruschke C, Buckingham ET, Buttlaire S, Clarke G, Coleman K, Flores JP, Frank C, Penfold RB, Richardson L, Ryan JM, Schoenbaum M, Sterling S, Stewart C, Yarborough BJH, Yeh HH, Ahmedani B. Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation. Psychiatr Serv 2024:appips20230211. [PMID: 38566561 DOI: 10.1176/appi.ps.20230211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The authors measured implementation of Zero Suicide (ZS) clinical practices that support identification of suicide risk and risk mitigation, including screening, risk assessment, and lethal means counseling, across mental health specialty and primary care settings. METHODS Six health care systems in California, Colorado, Michigan, Oregon, and Washington participated. The sample included members ages ≥13 years from 2010 to 2019 (N=7,820,524 patients). The proportions of patients with suicidal ideation screening, suicide risk assessment, and lethal means counseling were estimated. RESULTS In 2019, patients were screened for suicidal ideation in 27.1% (range 5.0%-85.0%) of mental health visits and 2.5% (range 0.1%-35.0%) of primary care visits among a racially and ethnically diverse sample (44.9% White, 27.2% Hispanic, 13.4% Asian, and 7.7% Black). More patients screened positive for suicidal ideation in the mental health setting (10.2%) than in the primary care setting (3.8%). Of the patients screening positive for suicidal ideation in the mental health setting, 76.8% received a risk assessment, and 82.4% of those identified as being at high risk received lethal means counseling, compared with 43.2% and 82.4%, respectively, in primary care. CONCLUSIONS Six health systems that implemented ZS showed a high level of variation in the proportions of patients receiving suicide screening and risk assessment and lethal means counseling. Two opportunities emerged for further study to increase frequency of these practices: expanding screening beyond patients with regular health care visits and implementing risk assessment with lethal means counseling in the primary care setting directly after a positive suicidal ideation screening.
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Affiliation(s)
- Jennifer M Boggs
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Julie Richards
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Gregory Simon
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Erika M Aguirre-Miyamoto
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Lee J Barton
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Arne Beck
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Rinad S Beidas
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Cambria Bruschke
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Edward T Buckingham
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Stuart Buttlaire
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Gregory Clarke
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Karen Coleman
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Jean P Flores
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Catherine Frank
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Robert B Penfold
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Laura Richardson
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Jacqueline M Ryan
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Michael Schoenbaum
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Stacy Sterling
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Christine Stewart
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Bobbi Jo H Yarborough
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Hsueh-Han Yeh
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Brian Ahmedani
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
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Simon GE, Cruz M, Shortreed SM, Sterling SA, Coleman KJ, Ahmedani BK, Yaseen ZS, Mosholder AD. Stability of Suicide Risk Prediction Models During Changes in Health Care Delivery. Psychiatr Serv 2024; 75:139-147. [PMID: 37587793 DOI: 10.1176/appi.ps.20230172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE The authors aimed to use health records data to examine how the accuracy of statistical models predicting self-harm or suicide changed between 2015 and 2019, as health systems implemented suicide prevention programs. METHODS Data from four large health systems were used to identify specialty mental health visits by patients ages ≥11 years, assess 311 potential predictors of self-harm (including demographic characteristics, historical risk factors, and index visit characteristics), and ascertain fatal or nonfatal self-harm events over 90 days after each visit. New prediction models were developed with logistic regression with LASSO (least absolute shrinkage and selection operator) in random samples of visits (65%) from each calendar year and were validated in the remaining portion of the sample (35%). RESULTS A model developed for visits from 2009 to mid-2015 showed similar classification performance and calibration accuracy in a new sample of about 13.1 million visits from late 2015 to 2019. Area under the receiver operating characteristic curve (AUC) ranged from 0.840 to 0.849 in the new sample, compared with 0.851 in the original sample. New models developed for each year for 2015-2019 had classification performance (AUC range 0.790-0.853), sensitivity, and positive predictive value similar to those of the previously developed model. Models selected similar predictors from 2015 to 2019, except for more frequent selection of depression questionnaire data in later years, when questionnaires were more frequently recorded. CONCLUSIONS A self-harm prediction model developed with 2009-2015 visit data performed similarly when applied to 2015-2019 visits. New models did not yield superior performance or identify different predictors.
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Affiliation(s)
- Gregory E Simon
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Maricela Cruz
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Susan M Shortreed
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Stacy A Sterling
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Karen J Coleman
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Brian K Ahmedani
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Zimri S Yaseen
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Andrew D Mosholder
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
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