Alcohol Use Disorder Treatment Simulation: Modeling treatment impacts on alcohol-related disparities

项目总结/摘要 过度饮酒造成巨大的经济和社会成本，是可预防疾病的主要原因。 死在美国。只有一小部分酒精使用障碍（AUD）患者接受适当的治疗。 服务，人们在获得酒精健康服务方面存在很大差异， 种族/民族、性别、社会经济地位和城市化。拟议的研究将回答紧迫的问题， 关于如何减少访问差异的问题，使用模拟建模来检查是否 普遍增加获得循证实践（EBP）的机会，如筛查、简短干预， 转诊治疗（SBIRT）或药物辅助治疗可以减少差异，或者是否更多 需要作出有针对性的努力，改善获得服务的机会，以惠及高度优先的人口亚群。仿真 模型非常适合于识别复杂环境中实施的干预措施的意外后果 系统，以及实施后可能出现的结果。通过预测干预效果 随着时间的推移，模拟建模可以帮助识别和优先考虑酒精类型 卫生服务干预措施，以减少澳元差距。虽然模拟方法被用来 为了解决阿片类药物危机，迄今为止还没有发表的模拟模型全面描述 与澳元差距有关的酒精健康服务的连续性。拟议的研究填补了这一空白， 模拟在SBIRT的连续护理中增加获得酒精健康服务的影响， 专科护理（包括AUD药物）和非正式治疗（包括12步小组， 匿名酗酒者），与健康差距有关。首先，我们将建立和校准一个微观模拟 为轻度、中度和重度AUD患者提供酒精健康服务的模式，由概念指导 该模式包括个人、组织、社区和政策层面的治疗障碍。接下来， 我们将使用一个地理位置的模拟人口代表大，人口统计学和 地理位置不同的加州和德克萨斯州对澳元严重程度进行长期预测， 关键人群亚组随时间的恢复。最后，根据医疗保健可及性理论， 利用率，我们将在几个增强条件下预测AUD治疗差异的变化，以确定 服务的组合和分布，最能减少差距，我们估计的成本和效益， 改善服务准入。研究的目的是评估（1）普遍实施EBP的影响， 传统和非传统环境，以及（2）改善可获得性、可用性、可负担性， 酒精卫生服务的可接受性差异，以及（3）估计成本和成本效益， 这些变化。调查结果将提供详细信息，为各州、县和 社区改善卫生服务，包括预测如何以及在何处进行干预， 这是一种有效的方式，可以减轻澳元的负担，并增加弱势群体的长期恢复。

PROJECT SUMMARY/ABSTRACT Excessive drinking results in tremendous economic and social costs and is a leading cause of preventable death in the US. Only a small minority of people with alcohol use disorder (AUD) receive appropriate services, and there are large disparities in access to alcohol health services for people based on race/ethnicity, gender, socioeconomic status, and urbanicity. The proposed study will answer pressing questions about how to reduce disparities in access, using simulation modeling to examine whether universal increases in access to evidence-based practices (EBPs) such as screening, brief intervention, and referral to treatment (SBIRT) or medication-assisted treatment can reduce disparities, or whether more targeted efforts to improve access are needed to reach high-priority population subgroups. Simulation models are well-suited for identifying unintended consequences of interventions implemented in complex systems, as well as outcomes that may occur years after implementation. By projecting intervention effects across population subgroups over time, simulation modeling can help identify and prioritize types of alcohol health services interventions to reduce AUD disparities. Although simulation methods are being used to address the opioid crisis, to date there is no published simulation model comprehensively describing the continuum of alcohol health services in relation to AUD disparities. The proposed study fills this gap by simulating effects of increased access to alcohol health services across the continuum of care from SBIRT, to specialty care (including AUD medications) and informal treatment (including 12-step groups like Alcoholics Anonymous), in relation to health disparities. First, we will build and calibrate a microsimulation model of alcohol health services for people with mild, moderate, and severe AUD, guided by a conceptual model that includes barriers to treatment at the individual, organizational, community, and policy levels. Next, we will use a geographically situated simulated population representing the large, demographically and geographically diverse states of California and Texas to make long-term projections for AUD severity and recovery for key population subgroups over time. Finally, informed by theories of healthcare access and utilization, we will project changes in AUD treatment disparities under several enhanced conditions to identify the mix and distribution of services that would best reduce disparities, and we estimate costs and benefits of improved service access. Study Aims are to assess effects of (1) universal implementation of EBPs in traditional and non-traditional settings and (2) improving accessibility, availability, affordability, and acceptability of alcohol health services on disparities, and to (3) estimate cost and cost-effectiveness of these changes. Results will provide detailed information to inform service planning by states, counties, and communities to improve health services, including projections for how and where to intervene in a cost- effective manner to reduce the burden of AUD and increase long-term recovery for vulnerable populations.