IAMSBIRT: Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers

IAMSBIRT：在国家儿科创伤中心队列中实施酒精滥用 SBIRT

• 批准号: 10430304
• 负责人: Michael J Mello
• 金额: $ 18.71万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10430304
• 关键词: Address; Adolescent; Adopted; Adoption; Alcohol or Other Drugs use; American College of Surgeons; Analgesics; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Clinical; Computerized Medical Record; Counseling; Data; Data Collection; Development; Drug Screening; Drug usage; Effectiveness; Elements; Feedback; Funding; Goals; Health Personnel; Hospitals; Intervention; Laboratories; Leadership; Mediating; Methods; Nurses; Opioid; Organizational Change; Patients; Pediatric cohort; Performance; Pharmaceutical Preparations; Pharmacotherapy; Provider; Public Health; Recording of previous events; Reporting; Research; Risk; Science; Services; Site; Social Workers; Source; Technology Transfer; Time; Training; Trauma patient; Treatment Protocols; United States Substance Abuse and Mental Health Services Administration; addiction; adolescent patient; alcohol and other drug; alcohol misuse; alcohol screening; alcohol screening and brief intervention; base; brief intervention; care providers; clinical care; cohort; design; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; evidence base; implementation research; implementation science; implementation strategy; implementation study; implementation trial; improved; injured; opioid misuse; organizational readiness; pain patient; patient oriented; pediatric trauma; prescription pain reliever; public health relevance; screening; screening, brief intervention, referral, and treatment; social organization; trauma centers; treatment adherence

PROJECT SUMMARY In 2006, the American College of Surgeons (ACS) adopted a requirement for certification as a level one trauma center that mandated universal screening for alcohol misuse and delivery of a brief intervention for those screening positive. Though this requirement has been mandated for a decade, its implementation has been challenging, especially for pediatric trauma centers. Our research team completed a CDC funded implementation study supporting seven pediatric trauma centers' compliance with the ACS requirement by developing and implementing an institutional alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol for adolescent trauma patients. A mixed-methods approach indicated that SBIRT adoption rates increased at all sites; however, providers' fidelity to the SBIRT intervention was variable, and providers reported a number of barriers to SBIRT implementation. The goal of this application is to conduct a fully powered Type III hybrid effectiveness-implementation trial to test the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug use in pediatric trauma centers. Our implementation strategy is based on the Science to Service Laboratory (SSL), an approach developed by the SAMHSA-funded Addiction Technology Transfer Centers (ATTCs) that consists of the same three core elements (i.e., didactic training + performance feedback + leadership coaching) used in our CDC study. Based on feedback from the CDC study, two enhancements were made to the SSL strategy: 1) integration of the intervention into the electronic medical record as a means of improving SBIRT adherence; and 2) development of separate training tracks for nurses, social workers and organizational leaders to meet the unique needs of each group. In addition, we integrate counseling around the use of prescription pain relievers into the SBIRT intervention as an Exploratory Aim, since most pediatric trauma center patients are discharged on pain medication and patients with a history of AOD use are at elevated risk of opioid misuse. Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers will receive the SSL implementation strategy. Data collection for this study relies on multiple sources. At six distinct time points, each of the 10 sites will provide data from 30 EMR charts (n = 1800 charts in total). A subset of adolescents will also report on fidelity of intervention delivery and linkage to care (i.e., continued AOD discussion and/or treatment with a primary care provider) 1 month post hospital discharge. In addition, nurses, social workers, and leaders from each pediatric trauma center will report on organizational readiness for implementation at three distinct time points. Results of this study will demonstrate that a highly scalable implementation strategy, adapted for pediatric trauma centers from the results of our mixed-methods implementation trial, will improve the fidelity (i.e., the consistency and quality) of SBIRT delivery in pediatric trauma centers.

项目摘要 2006年，美国外科医生学会（ACS）通过了一项要求，即一级创伤必须经过认证 该中心要求对酒精滥用进行普遍筛查，并为那些 筛查阳性虽然这一要求已被授权十年，但其执行一直是 这是一个挑战，尤其是对儿科创伤中心来说。我们的研究团队完成了一项由CDC资助的 实施研究支持七个儿科创伤中心符合ACS要求， 制定和实施机构酒精筛查、短暂干预和转诊治疗计划 （SBIRT）协议为青少年创伤患者。混合方法的方法表明，SBIRT的采用 所有站点的比率都有所增加;然而，提供者对SBIRT干预的忠诚度是可变的， 报告了SBIRT实施的一些障碍。此应用程序的目标是进行全面的 动力III型混合动力的有效性-实施试验，以测试一个全面的有效性 在儿童中增加酒精和其他药物使用SBIRT的实施策略 创伤中心我们的实施战略是基于科学服务实验室（SSL）， 由SAMHSA资助的成瘾技术转让中心（ATTC）开发的方法，包括 相同的三个核心元件（即，教学培训+绩效反馈+领导力辅导）， 我们疾控中心的研究根据CDC研究的反馈，对SSL策略进行了两项改进： 1)将干预措施整合到电子病历中，作为提高SBIRT依从性的一种手段; 和2）为护士、社会工作者和组织领导人制定单独的培训轨道， 每个群体的独特需求。此外，我们整合咨询围绕使用处方疼痛 作为探索性目标，SBIRT干预的缓解者，因为大多数儿科创伤中心的患者 出院后服用止痛药和有AOD使用史的患者阿片类药物滥用的风险增加。 利用阶梯式楔形设计，全国10个儿科创伤中心的队列将接受SSL 实施战略本研究的数据收集依赖于多个来源。在六个不同的时间点， 10个研究中心中的每个将提供来自30个EMR图表的数据（总共n = 1800个图表）。青少年的一个子集 还将报告干预交付的保真度和与护理的联系（即，继续讨论机场启用日期及/或 由初级保健提供者治疗）出院后1个月。此外，护士、社工、 来自每个儿科创伤中心的领导将报告组织准备实施情况， 三个不同的时间点这项研究的结果将表明，一个高度可扩展的实施战略， 从我们的混合方法实施试验的结果中， 保真度（即，一致性和质量）。

项目成果

Screening Adolescent Trauma Patients for Substance Use at 10 Pediatric Trauma Centers.

• DOI: 10.1097/jtn.0000000000000537
• 发表时间: 2020
• 期刊: Journal of trauma nursing : the official journal of the Society of Trauma Nurses
• 作者: Mello MJ;Becker SJ;Spirito A;Bromberg JR;Wills H;Barczyk A;Lee L;Pruitt C;Ebel BE;Zonfrillo MR;Nimaja E;Scott K;Kiragu A;Nasr IW;Aidlen JT;Maxson RT;Baird J
• 通讯作者: Baird J

Developing and Implementing Electronic Consent Procedures in Response to Covid-19 Restrictions.

• DOI: 10.1002/eahr.500135
• 发表时间: 2022-07-01
• 期刊: Ethics & human research
• 作者: Bromberg, Julie R;Nimaja, Evelyn;Mello, Michael J
• 通讯作者: Mello, Michael J