Implementing Mobile Technology for Unhealthy Alcohol Use in Emergency Departments

在急诊科实施移动技术以解决不健康的饮酒问题

• 批准号: 10350216
• 负责人: Megan Alison O'Grady
• 金额: $ 27.03万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10350216
• 关键词: Accident and Emergency department; Address; Administrator; Adopted; Adoption; Adult; Alcohol consumption; Alcohols; Area; COVID-19 pandemic; Caring; Collaborations; Country; Data; Effectiveness; Electronic Health Record; Emergency Department patient; Emergency department visit; Enrollment; Frequencies; Future; General Population; Health Services; Health Technology; Health behavior; Health system; Individual; Intervention; Interview; Meta-Analysis; Methods; Nature; Outcome; Patients; Pilot Projects; Population; Premature Mortality; Process; Promoting Action on Research Implementation in Health Services framework; Provider; Randomized; Research; Research Support; Resources; Sampling; Site; Structure; Surveys; Technology; Testing; Text; Text Messaging; Time; Training; Trauma patient; United States; United States National Institutes of Health; Work; alcohol involvement; alcohol misuse; alcohol screening; arm; base; behavioral health intervention; drinking; effectiveness implementation study; effectiveness implementation trial; emergency settings; evidence base; health care settings; implementation barriers; implementation facilitators; implementation strategy; interest; intervention mapping; mHealth; mobile computing; patient screening; pragmatic implementation; randomized trial; reduced alcohol use; response; screening and brief intervention; screening program; substance use; text messaging intervention

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.

项目摘要 不健康的酒精使用是导致美国成年人过早死亡的主要原因之一 在新冠肺炎大流行期间，这一数字一直在增加。在紧急情况中，UAU更频繁 部门(ED)患者比一般人群和因饮酒而前往ED就诊的患者 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 ED中的行为，ED已被强调为干预UAU个人的关键设置。 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 但往往时间和资源有限。移动技术被建议作为一种解决方案来帮助 EDS在解决UAU方面的负担最低、可扩展的方法之一是短信干预。 针对ED和创伤患者及其他人群的短信干预已显示出良好的效果， 包括减少饮酒量和饮酒频率。尽管有强有力的研究支持和承诺 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 实施到医疗保健环境中。很少有研究表明，技术干预对行为 将健康投入到现实世界的医疗保健环境中；已经进行的那些表明，所看到的好处 在随机试验中往往没有实现。虽然ED是使用文本解决UAU的有希望的场所 消息传递干预，即提供者以有效方式将其提供给患者的过程 已经繁忙且负担过重的急诊工作流程(即，在真实的急诊环境中实施)和患者 采用它们仍然是一个新的研究领域。这项建议建立在我们长期合作的基础上 医疗保健中实施物质使用筛查和简要干预的跨学科小组 设置。为了回应NIH关于紧急情况下研究的特殊兴趣的通知，我们建议 检查员工提供和患者接受短信的潜在障碍和促进者 对急诊室的干预。然后，我们将使用利益相关者参与的干预映射流程来制定 面向EDS的多组件实现策略。最后，我们将进行混合方法2臂集群- 在每年为大约13,000名UAU患者服务的4家急诊室进行的随机试点研究，以评估其可行性， 实施战略的可接受性和初步有效性。的综合促进行动 卫生服务研究实施(I-PARIHS)框架将指导研究活动。低负担 技术，如文本消息，以及确定的目标实施支持和战略 障碍和促进者可以支持基于ED的大规模酒精筛查计划，并提供 需要对筛查呈阳性的患者提供支持，同时减轻急救人员的负担。拟议的研究将是 第一个开发和测试这一有针对性的实施战略。这款为期2年的R21将为未来做好准备， 规模更大、动力十足的混合效能--实施试验。