Understanding practical alcohol measures in primary care to prepare for measurement-based care: Scaled EHR measures of alcohol use and DSM-5 AUD symptoms

总结。这份多样性补充材料将支持罗伯特·埃利斯，MHA，一位有天赋的卫生学博士生 华盛顿大学的系统和人口健康项目，他作为一名 独立的NIAAA调查员。埃利斯先生的研究重点是重叠的边缘化身份如何影响 关爱澳元。他设计了一篇创新的论文，并招募了一个强大的导师委员会。凯文 Hallgren博士，母公司R33研究(2021-2024)的首席研究员(PI)将是埃利斯先生的主要研究人员 导师；凯瑟琳·布拉德利，医学博士，公共卫生硕士，凯撒永久华盛顿公司母公司R33的现场PI，主席 埃利斯先生的学位论文委员会的成员将成为共同导师。家长R33旨在改善不健康的衡量标准 酒精使用和酒精使用障碍(AUD)记录在电子健康记录(EHR)中，作为 常规医疗护理。R33使用来自700,000多名成人初级保健患者的辅助数据来评估 两种定标措施的关联-AUDIT-C酒精筛查和有效的DSM-5酒精 症状清单--有5种健康结果。父R33的具体目标是评估：1) AUDIT-C评分与血压、抑郁、因饮酒住院的关系 病情、全因住院和死亡，2)AUD症状和5种疾病之间的关系 计入AUDIT-C分数后的结果，以及3)重复审计变化之间的关联- C衡量和改变这5种健康结果的风险。父R33不评估AUD诊断 或使用污名化的AUD标签；它也不基于重叠来评估不同亚组的结果 性别、种族/民族或社会经济地位(SES)的身份。拟议的多样性补编涉及 通过评估与医疗提供者的AUD诊断记录相关的因素 常规临床护理期间的EHR。拟议的多样性补充研究的具体目标是：1) 描述不同亚组的成人患者在初级保健就诊时被诊断为AUD的概率 基于性别、种族/民族和SES的交集；2)描述被诊断的概率 在酒精消费和澳元水平相近的性别和种族/民族的交叉点上的澳元 症状；以及3)描述供应商在电子病历中选择污名化标签的概率 根据性别和种族/民族的交集诊断AUD。埃利斯先生的职业发展和 导师计划将支持埃利斯先生在以下方面的发展：1)酒精相关健康服务方面的专业知识和技能 研究和应用差异研究；2)作为一名研究人员逐步独立，由AT证明 至少发表5篇论文(3篇为第一作者)；以及3)申请并获得竞争性博士后奖学金或 F32个人奖学金。埃利斯先生将通过有组织的和应用的培训来实现这些目标， 关于Hallgren博士和Bradley博士的指导(≥，每周3小时)，外加4位内容导师的支持。冲击力。 拟议的附录将向R33的所有目标提供信息，重点是酒精可归因性条件。

SUMMARY. This Diversity Supplement would support Robert Ellis, MHA, a talented PhD student in the Health Systems and Population Health program at the University of Washington, who has outstanding potential as an independent NIAAA investigator. Mr. Ellis’ research focuses on how overlapping marginalized identities impact care for AUD. He has designed an innovative dissertation and recruited a strong committee of mentors. Kevin Hallgren, PhD, principal investigator (PI) of the Parent R33 Study (2021-2024) will be Mr. Ellis’s primary mentor; Katharine Bradley, MD, MPH, Site PI of the Parent R33 at Kaiser Permanente Washington, and Chair of Mr. Ellis’ Dissertation Committee, will be co-mentor. The Parent R33 aims to improve measures of unhealthy alcohol use and alcohol use disorders (AUD) documented in electronic health records (EHRs) as part of routine medical care. The R33 uses secondary data from over 700,000 adult primary care patients to evaluate the association of two scaled measures—the AUDIT-C alcohol screen and a validated DSM-5 Alcohol Symptom Checklist—with 5 health outcomes. Specific Aims of the Parent R33 are to evaluate: 1) the associations of AUDIT-C scores with blood pressure, depression, hospitalizations for alcohol-attributable conditions, all-cause hospitalizations, and death, 2) the associations between AUD symptoms and the 5 outcomes after accounting for AUDIT-C scores, and 3) the associations between changes in repeated AUDIT- C measures and changes in risk of the 5 health outcomes. The Parent R33 does not evaluate AUD diagnoses or use of stigmatized labels for AUD; nor does it evaluate outcomes across subgroups based on overlapping identities of sex, race/ethnicity, or socioeconomic status (SES). The proposed Diversity Supplement addresses these issues by evaluating factors associated with medical providers’ documentation of AUD diagnoses in the EHR during routine clinical care. The Specific Aims of the Proposed Diversity Supplement Research are: 1) to describe the probability of adult patients being diagnosed with AUD at primary care visits across subgroups based on the intersections of sex, race/ethnicity, and SES; 2) to describe the probability of being diagnosed with AUD across intersections of sex and race/ethnicity at similar levels of alcohol consumption and AUD symptoms; and 3) to describe the probability of providers selecting a stigmatized label in the EHR when diagnosing AUD based on the intersection of sex and race/ethnicity. Mr. Ellis’ Career Development and Mentoring Plan will support Mr. Ellis as he develops: 1) expertise and skills in alcohol-related health services research and applied disparities research; 2) progressive independence as an investigator, demonstrated by at least 5 publications (3 first-authored); and 3) applies for and obtains a competitive post-doctoral fellowship or an F32 individual fellowship. Mr. Ellis will achieve these objectives via structured and applied training, hands- on mentoring (≥3 hours a week) by Drs. Hallgren and Bradley, plus support from 4 content mentors. Impact. The proposed supplement will inform all Aims of the R33 focused on alcohol-attributable conditions.