Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes

在卫生系统中实施酒精筛查和短暂干预：可持续性、忠诚度和患者结果

• 批准号: 10172807
• 负责人: Stacy Ann Sterling
• 金额: $ 47.97万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10172807
• 关键词: Address; Adoption; Adult; Affect; Alcohol consumption; Alcohols; Benchmarking; California; Cessation of life; Clinic; Clinical; Clinical Trials; Cluster randomized trial; Data; Early Intervention; Electronic Health Record; Elements; Environment; Frequencies; Health; Health Care Costs; Health system; Healthcare Systems; Heavy Drinking; Hybrids; Infrastructure; Intervention; Interview; Literature; Measures; Medical; Medical center; Methodology; Methods; Modality; Modeling; Morbidity - disease rate; Outcome; Outcome Study; Patient Care; Patient-Focused Outcomes; Patients; Performance; Physicians; Population; Population Study; Practical, Robust Implementation and Sustainability Model; Primary Health Care; Provider; Public Health; Reporting; Research; Standardization; Surveys; System; Telephone Interviews; Time; Variant; alcohol misuse; alcohol screening; alcohol screening and brief intervention; base; brief intervention; care providers; cost; cost effectiveness; dissemination research; drinking; evidence base; experience; hazardous drinking; health care delivery; health care service utilization; health service use; implementation intervention; implementation outcomes; implementation research; improved; informant; innovation; mortality; multilevel analysis; population based; primary care setting; public health relevance; response; screening; screening and brief intervention; success; theories

ABSTRACT Hazardous drinking is a significant public health problem, affecting approximately 20% of U.S. adult primary care patients, contributing to about 65,000 deaths and costing the US health system more than $250 billion annually. Clinical trials have documented the efficacy and cost-effectiveness of Alcohol Screening and Brief Intervention (ASBI), including in the health system studied here, and it is now a widely-endorsed approach to identification and early intervention for hazardous use. However, relatively few studies have examined real-world ASBI implementation and, its long-term sustainability, and their relationship to patient outcomes, utilization and cost. This study will take advantage of an ongoing health system-wide ASBI initiative in a large, heterogeneous health care delivery system, Kaiser Permanente Northern California, which in 2013 incorporated ASBI into its adult primary care workflow and conducts an average of 145,000 screenings and 9,500 brief intervention (BIs) monthly for adult primary care patients. Using a theory-driven conceptual framework, this innovative study will rigorously examine the factors which facilitate or impede successful real- world ASBI implementation and long-term sustainability. Guided by the PRISM (Practical, Robust Implementation and Sustainability Model) framework, this mixed-methods study will use electronic health record (EHR) data from 1/1/2014 to 12/31/2021, along with primary care provider surveys, patient telephone interviews, and qualitative key informant interviews to examine ASBI implementation (1/1/2014 – 12/31/2015), short-term sustainability (1/1/2016-12/31/2018) and long-term sustainability (1/1/2019 – 12/31/2021) outcomes (screening and BI rates); patient outcomes (heavy drinking days and typical drinking quantity and frequency, health services utilization and costs); and the fidelity and quality of BIs. We will use the PRISM domains to enhance our understanding of ASBI implementation and long-term sustainability. First, we will employ indirect standardization (observed-to-expected ratios) methodology to benchmark ASBI implementation, short- and long-term sustainability performance over 8 years and examine associating factors. Second, we will conduct multi-level models analyses to determine whether and how ASBI implementation and sustainability are related to patient drinking outcomes and use of health services and costs. Finally, we will measure BI fidelity and quality by asking patients and PCPs about their experiences receiving and delivering BIs, and examine how they are related to patient outcomes. Results will provide concrete, pragmatic guidance on factors which facilitate successful ASBI implementation and long-term sustainability that can be used widely by this and other health systems to improve how we identify and treat the full spectrum of unhealthy alcohol use, and how we implement, sustain and study population-based responses to it.

抽象的 有害饮酒是一个重大的公共卫生问题，影响着大约 20% 的美国成年人 初级保健患者，造成约 65,000 人死亡，美国卫生系统损失超过 250 美元 每年亿。临床试验记录了酒精筛查和酒精筛查的功效和成本效益 简短干预（ASBI），包括这里研究的卫生系统，它现在是一种得到广泛认可的方法 危险用途识别和早期干预的方法。然而，相对较少的研究 研究了现实世界中 ASBI 的实施及其长期可持续性及其与患者的关系 结果、利用率和成本。这项研究将利用正在进行的整个卫生系统 ASBI 计划 在一个大型、异构的医疗保健提供系统中，北加州凯撒医疗机构 (Kaiser Permanente Northern California) 于 2013 年 将 ASBI 纳入其成人初级保健工作流程，并平均进行 145,000 次筛查和 每月为成年初级保健患者提供 9,500 次简短干预 (BI)。使用理论驱动的概念 框架，这项创新研究将严格审查促进或阻碍成功现实的因素 世界 ASBI 实施和长期可持续性。以 PRISM（实用、稳健 实施和可持续性模型）框架，这项混合方法研究将使用电子健康 2014年1月1日至2021年12月31日的记录（EHR）数据，以及初级保健提供者调查、患者电话 访谈和定性关键知情人访谈，以检查 ASBI 实施情况（2014 年 1 月 1 日 – 12/31/2015）、短期可持续性（1/1/2016-12/31/2018）和长期可持续性（1/1/2019 – 2021 年 12 月 31 日）结果（筛查和 BI 率）；患者结果（酗酒日和典型饮酒 数量和频率、卫生服务利用和成本）；以及 BI 的保真度和质量。我们将使用 PRISM 领域，以增强我们对 ASBI 实施和长期可持续性的理解。第一的， 我们将采用间接标准化（观察与预期比率）方法来衡量 ASBI 实施情况、8 年的短期和长期可持续发展绩效，并检查相关因素。 其次，我们将进行多层次模型分析，以确定 ASBI 是否以及如何实施和 可持续性与患者饮酒结果以及卫生服务的使用和成本有关。最后，我们将 通过询问患者和 PCP 接受和交付的经历来衡量 BI 保真度和质量 BI，并检查它们与患者结果的关系。结果将提供具体、务实的指导 促进 ASBI 成功实施和长期可持续性的因素 被本卫生系统和其他卫生系统广泛采用，以改善我们识别和治疗各种不健康疾病的方式 饮酒，以及我们如何实施、维持和研究基于人群的饮酒应对措施。