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.

项目总结/文摘