Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes

项目概要/摘要 COVID-19大流行导致酒精患者的虚拟治疗发生了巨大转变 问题这种转变引发了人们对获得虚拟治疗的潜在差异的质疑， 考虑到现有的“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 装置.患者还可能面临保密问题、缺乏私人空间等障碍 参与虚拟疗程以及对虚拟治疗体验的不满。在 同时，虚拟治疗的特点，如方便和消除 交通及其费用，可能会增加获得和使用，特别是对于任职人数偏低的人来说， 患者人群。这项拟议中的研究调查了在虚拟酒精治疗之间的差异， 酒精问题患者，定义为过度饮酒和酒精使用障碍 (AUD)在一个大型、多样化的医疗保健提供系统中， 在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，我们研究了酒精问题识别的变化，以及几种治疗措施， （短期干预，药物治疗，启动，参与和保留专业） 成瘾治疗）比较访问类型（虚拟/非虚拟，电话，视频）从一个前， COVID-19（2019年3月至2019年12月）至COVID-19发病后（2020年3月至2020年12月）的时间段。与 205，293名酒精问题患者的大样本，我们将专门探讨差异 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。我们探讨在这个动荡时期的差别保险损失，以及 卫生服务利用率（如急诊科、初级保健、精神病学、电子邮件安全 （一）研究人群。我们严格的分析计划包含中断时间 系列（ITS）和广义估计方程（GEE）模型，以解决研究目标。早期 有证据表明，在COVID-19大流行期间，酒精问题有所增加， 虚拟治疗在大流行后可能会继续作为一种重要的治疗方式。结果 对病人护理有重要意义，特别是对提高护理质量， 弱势群体。此外，研究队列将是未来研究的宝贵资源 虚拟酒精治疗及其对患者结局的长期影响。

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.