ABSTRACT Suicide is a major public health concern ? it is the 10th leading cause of death and number one cause of injury related death in the United States (US). Due to national concern about this problem, the National Action Alliance for Suicide Prevention and the US Surgeon General published the joint 2012 National Strategy for Suicide Prevention (NSSP). The NSSP outlines a series of Aspirational Goals (AG) with the specific objective to reduce the national suicide rate by 20%. AG 8 and 9 promote healthcare settings as primary targets for suicide prevention. Consistent with this message, Henry Ford Health System's (HFHS) Perfect Depression Care (PDC) Zero Suicide Initiative was the first US program linked with a substantial decrease in the suicide rate among behavioral health patients after implementation. These findings have motivated national promotion of this model for suicide prevention in health systems. As such, the National ZS Model (NZSM) was developed, based on the HFHS PDC program, but with flexibility to allow adaptation to diverse settings and patient populations. Overall, the NZSM is founded on the realization that suicidal individuals often fall through multiple cracks in a fragmented and sometimes distracted healthcare system, and on the premise that a systematic, comprehensive approach to care is necessary for suicide prevention. The comprehensive approach of the NZSM includes implementation of a series of clinical and quality strategies within the following components: 1) Identification of those at-risk, 2) Engagement and care management; 3) Effective treatment, and 4) Care transition. Despite being a model program promoted internationally for healthcare system quality improvement in suicide prevention, the NZSM has very limited evidence outside of the findings from the HFHS PDC program. The proposed study seeks to conduct a comprehensive process and outcome evaluation of NZSM implementation in real-world clinical settings across 6 large, diverse Mental Health Research Network affiliated Learning Healthcare Systems providing healthcare for over 9 million individuals each year. The project aims are to:1) Collaborate with health system leaders to develop EHR metrics to measure specific quality improvement targets and care processes tailored to local NZSM implementation, 2) Examine the fidelity of the specific NZSM care processes implemented in each system, and 3) Investigate suicide attempt and mortality outcomes within and across NZSM system models. Study data are captured using electronic health records and insurance claims. Given strong national support for NZSM, if it is found to be effective to reduce suicide behavior, this model will have nationwide implications for suicide prevention in healthcare settings.