IAMSBIRT: Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers

项目摘要 美国外科医生学会要求对酒精滥用进行普遍筛查， 为那些筛查阳性的人提供干预，作为一级创伤中心认证的要求。虽然 这一要求已被授权十多年，其实施一直具有挑战性，特别是 儿科创伤中心我们目前资助的研究，IAMSBIRT，测试了一个全面的 实施战略，以增加对酒精和其他药物使用的SBIRT（AOD）的实施， 儿科创伤中心通过III型混合有效性实施试验。这一目标实现了 通过：主要目标：评估SSL实施策略在提高 儿科创伤中心的SBIRT实施，相对于常规实施;次要目标1：评价 组织变革的准备程度是否调节SSL实施策略对 执行效率（即，SBIRT输送的保真度）;次要目的2：评价SSL的效果 改善病人与适当护理联系的实施战略（即，继续与 初级保健提供者和/或AOD治疗）;以及 探索性目的：检查关于使用处方止痛药的咨询整合， SBIRT交付与受伤的青少年患者谁屏幕积极为AOD使用。利用阶梯式楔块 设计，10个儿科创伤中心的国家队列接受SSL实施策略。在六个不同的 每个站点提供来自30份电子健康记录（EHR）样本的数据; 青少年报告了提供干预措施的忠实性以及与护理的联系。每个儿科的临床工作人员 创伤中心在三个不同时间点的组织实施准备情况报告。的 行政补充要求将扩大我们的EHR审查，以所有承认的青少年在所有 楔形块（包括已经发生的楔形块），以检查提供者出院后30天的临床记录， 创伤中心就诊后与护理（AOD随访讨论/ AOD治疗）相关的证据。这 鉴于研究方案因以下原因发生变更，因此有必要进行变更，以有效检查次要目标2 2019冠状病毒病疫情。本研究的结果将表明，一个高度可扩展的实施战略将 提高保真度（即，一致性和质量）。

PROJECT SUMMARY The American College of Surgeons mandate universal screening for alcohol misuse and delivery of a brief intervention for those screening positive as a requirement for certification as a level one trauma center. Though this requirement has been mandated for over a decade, its implementation has been challenging, especially for pediatric trauma centers. Our currently funded study, IAMSBIRT, tests the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug (AOD) use in pediatric trauma centers through a Type III hybrid effectiveness-implementation trial. This goal is accomplished through: Primary Aim: Evaluate the effectiveness of the SSL implementation strategy in increasing fidelity of SBIRT delivery at pediatric trauma centers, relative to usual implementation; Secondary Aim 1: Evaluate whether readiness for organizational change mediates the influence of the SSL implementation strategy on implementation effectiveness (i.e., fidelity of SBIRT delivery); Secondary Aim 2: Evaluate the effect of the SSL implementation strategy on improving patient linkage to appropriate care (i.e., continued AOD discussion with primary care provider and/or AOD treatment) following discharge from pediatric trauma centers; and Exploratory Aim: Examine the integration of counseling regarding the use of prescription pain relievers into SBIRT delivery with injured adolescent patients who screen positive for AOD use. Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers receive the SSL implementation strategy. At six distinct time points, each site provides data from a sample of thirty electronic health records (EHRs); a subset of adolescents report on fidelity of intervention delivery and linkage to care. Clinical staff from each pediatric trauma center report on organizational readiness for implementation at three distinct time points. The administrative supplement requested will expand our EHR review to be of all admitted adolescents across all wedges (including those already occurred) to examine providers’ clinical notes 30 days post discharge for evidence of linkage to care (AOD follow up discussions/ AOD treatment) after the trauma center visit. This change is necessary to effectively examine Secondary Aim 2 given changes in the research protocol due to the COVID-19 pandemic. Results of this study will demonstrate that a highly scalable implementation strategy will improve the fidelity (i.e., the consistency and quality) of SBIRT delivery in pediatric trauma centers.