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: 10414232
• 负责人: Stacy Ann Sterling
• 金额: $ 8.2万
• 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/10414232
• 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

Project Summary/Abstract The COVID-19 pandemic has led to a dramatic shift to virtual treatment for patients with alcohol problems. This shift raises questions about potential disparities in access to virtual treatment, given the existing ‘digital divide,’ where older patients, patients of color, and patients of lower socio-economic status may have less access to broadband, computers, and other digital devices. Patients may also face barriers such as confidentiality concerns, lack of private space for participating in virtual sessions, and dissatisfaction with the virtual therapeutic experience. At the same time, features of virtual treatment, such as convenience and elimination of transportation and its costs, may increase access and use, particularly for underrepresented patient populations. The proposed study examines disparities in virtual alcohol treatment among patients with alcohol problems, defined as both excessive alcohol use and alcohol use disorder (AUD) in a large, diverse, health care delivery system that was able to quickly pivot to virtual alcohol treatment delivery during the pandemic. Using rich electronic health record and claims data, we examine changes in alcohol problem identification, and in several treatment measures (brief intervention, pharmacotherapy, and initiation, engagement, and retention in specialty addiction treatment) comparing visit types (virtual/non-virtual, telephone, video) from a pre- COVID-19 (3/2019-12/2019) to post-COVID-19 onset (3/2020-12/2020) time period. With a large sample of 205,293 patients with alcohol problems, we will specifically explore disparities by race/ethnicity, gender, age, and socioeconomic status, and examine different severity levels of alcohol problems. We explore differential insurance loss during this turbulent time, as well as health services utilization (e.g. emergency department, primary care, psychiatry, email secure messages) by the study population. Our rigorous analytic plan incorporates interrupted time series (ITS), and generalized estimating equation (GEE) models to address study aims. Early evidence suggests alcohol problems have increased during the COVID-19 pandemic, and virtual treatment will likely continue post-pandemic as an important treatment modality. Findings have important implications for patient care, particularly for improving quality of care for vulnerable populations. Further, the study cohort will be a valuable resource for future research on virtual alcohol treatment, and its long-term impact on patient outcomes.

项目概要/摘要 COVID-19 大流行导致酗酒患者转向虚拟治疗 问题。这种转变引发了有关获得虚拟治疗的潜在差异的问题， 鉴于现有的“数字鸿沟”，老年患者、有色人种患者和低收入患者 社会经济地位可能较少获得宽带、计算机和其他数字产品 设备。患者还可能面临保密问题、缺乏私人空间等障碍 参与虚拟会议以及对虚拟治疗体验的不满。在 同时，虚拟治疗具有方便、省去等特点。 运输及其成本，可能会增加获取和使用，特别是对于代表性不足的人 患者人群。拟议的研究调查了虚拟酒精治疗中的差异 有酒精问题的患者，定义为过度饮酒和酒精使用障碍 （澳元）在一个大型、多样化的医疗保健提供系统中，该系统能够快速转向虚拟 大流行期间提供酒精治疗。使用丰富的电子健康记录和索赔 数据，我们检查酒精问题识别和几种治疗措施的变化 （简短的干预、药物治疗以及专业的启动、参与和保留 成瘾治疗）比较预治疗的访问类型（虚拟/非虚拟、电话、视频） COVID-19（3/2019-12/2019）到 COVID-19 发病后（3/2020-12/2020）时间段。与一个 205,293名有酒精问题的患者的大样本，我们将专门探讨差异 按种族/民族、性别、年龄和社会经济地位，并检查不同的严重程度 酒精问题。我们探讨了这个动荡时期的差异保险损失，以及 卫生服务利用（例如急诊室、初级保健、精神病学、电子邮件安全 消息）由研究人群。我们严格的分析计划包含了中断时间 系列（ITS）和广义估计方程（GEE）模型来解决研究目标。早期的 有证据表明，在 COVID-19 大流行期间，酗酒问题有所增加，并且 虚拟治疗可能会在大流行后继续作为一种重要的治疗方式。发现 对患者护理具有重要意义，特别是对于提高护理质量 弱势群体。此外，研究队列将成为未来研究的宝贵资源 虚拟酒精治疗及其对患者结果的长期影响。