Implementing Mobile Technology for Unhealthy Alcohol Use in Emergency Departments

项目摘要 不健康的酒精使用（UAU）是美国成年人过早死亡的主要原因之一。 于2019冠状病毒病大流行期间一直增加。UAU在紧急情况中更常见 科室（艾德）患者比一般人群和涉及饮酒的艾德就诊者 近年来有所增加。物质使用被描述为最重要的可改变的健康 行为在艾德，和艾德已被强调为一个关键的设置干预UAU个人。 因此，全国各地的卫生系统需要低负担，可扩展的方式来干预个人 但通常具有有限的时间和资源。移动的技术已被建议作为一种解决方案， 解决UAU的ED和负担最低的，可扩展的方法之一是短信干预。 对艾德和创伤患者以及其他人群的短信干预显示出良好的结果， 包括减少饮酒量和频率。尽管有强大的研究支持和承诺， 可扩展性，几乎没有证据表明基于技术的行为健康干预可以有效地 实施到医疗机构中。很少有研究表明， 将健康置于真实的世界卫生保健环境中;已经进行的研究表明， 在随机试验中，往往无法实现。虽然ED是使用文本解决UAU的有希望的场所， 消息传递干预，提供者以有效的方式向患者提供这些干预的过程， 已经忙碌且负担过重的艾德工作流（即，在现实世界艾德环境中的实施）和患者 采用它们仍然是一个新的研究领域。该提案建立在我们与 在医疗保健中实施药物使用筛查和简单干预的跨学科小组 设置.为了响应NIH关于紧急情况下研究的特别关注通知，我们建议 检查工作人员提供和患者接受短信的潜在障碍和促进因素 在ED的干预。然后，我们将使用一个参与者参与的干预映射过程，以制定一个 ED的多组件实施战略。最后，我们将进行混合方法2臂集群- 在4个ED中进行的随机化初步研究，每年为约13，000名UAU患者提供服务，以评估可行性， 执行战略的可接受性和初步有效性。综合促进行动 卫生服务研究实施（i-PARIHS）框架将指导研究活动。低负担 技术，如短信，沿着有针对性的实施支持和战略， 障碍和促进者可以维持大规模的ED为基础的酒精筛查计划，并提供 需要对筛查阳性的患者提供支持，同时减轻ED的负担。拟议的研究将是 第一个制定和测试这一有针对性的实施战略。这两年的R21将为未来做准备， 更大的全动力混合动力有效性实施试验。

Project Summary Unhealthy alcohol use (UAU) is one of the leading causes of premature mortality among adults in the United States and has been increasing during the COVID-19 pandemic. UAU is more frequent among emergency department (ED) patients than in the general population and ED visits involving alcohol consumption have increased in recent years. Substance use has been described as the most important modifiable health behavior in the ED, and the ED has been highlighted as a key setting to intervene with UAU individuals. Consequently, health systems across the country need low burden, scalable ways to intervene with individuals but often have limited time and resources. Mobile technologies have been suggested as a solution to assist EDs in addressing UAU and one of the lowest burden, scalable approaches are text messaging interventions. Text messaging interventions for ED and trauma patients and other populations have shown good outcomes, including reductions in drinking quantity and frequency. Despite strong research support and promise for scalability, there is little evidence that technology-based behavioral health interventions can be effectively implemented into healthcare settings. There are few studies in which technology interventions for behavioral health are put into real world healthcare settings; those that have been conducted show that the benefits seen in randomized trials are often not realized. While EDs are promising venues for addressing UAU using text messaging interventions, the process of providers making them available to patients in an efficient way within already busy and overburdened ED workflows (i.e., implementation in real-world ED settings) and patients adopting them remains a new area of research. This proposal builds on the longstanding collaboration of our interdisciplinary team on the implementation of substance use screening and brief interventions in healthcare settings. In response to the NIH Notice of Special Interest for Research in the Emergency Setting, we propose to examine potential barriers and facilitators to staff offering and patients accepting a text messaging intervention in the ED. We will then use a stakeholder-engaged Intervention Mapping process to develop a multi-component implementation strategy for EDs. Finally, we will conduct a mixed method 2-arm cluster- randomized pilot study in 4 EDs that serve ~13,000 UAU patients per year to assess the feasibility, acceptability and preliminary effectiveness of the implementation strategy. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide study activities. Low burden technology, like text messaging, along with targeted implementation support and strategies driven by identified barriers and facilitators could sustain large-scale ED-based alcohol screening programs and provide much needed support to patients who screen positive while reducing burden on EDs. The proposed study would be the first to develop and test this targeted implementation strategy. This 2-year R21 will prepare for a future, larger, fully-powered hybrid effectiveness-implementation trial.