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

摘要这种多样性补充将支持罗伯特埃利斯，MHA，一个有才华的博士生在健康 华盛顿大学的系统和人口健康项目，他作为一名 独立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 关注AUD他设计了一个创新的论文，并招募了一个强大的导师委员会。凯文 Hallgren博士是R33母研究（2021-2024）的主要研究者（PI），他将是Ellis先生的主要研究人员。 导师; Katharine布拉德利，医学博士，公共卫生硕士，Kaiser Permanente华盛顿母公司R33的研究中心PI，以及主席 埃利斯先生论文委员会的委员将担任共同导师父母R33旨在改善不健康的措施 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70多万成人初级保健患者的二级数据来评估 两个规模化测量的关联-AUDIT-C酒精筛查和经验证的DSM-5酒精 症状检查表-5健康结果。父R33的具体目标是评估：1） AUDIT-C评分与血压、抑郁、因酒精引起的住院的相关性 条件，全因住院和死亡，2）AUD症状和5 解释AUDIT-C评分后的结果，以及3）重复AUDIT-C评分变化之间的关联。 C测量和5种健康结果的风险变化。父R33不评价AUD诊断 或使用AUD的污名化标签;也没有基于重叠评估亚组的结局 性别、种族/民族或社会经济地位（SES）。建议的多样性补充说明 这些问题通过评估与医疗提供者的AUD诊断文件相关的因素， 常规临床护理期间的EHR。建议的多样性补充研究的具体目的是：1） 描述各亚组中成人患者在初级保健访视时诊断为AUD的概率 基于性别、种族/民族和SES的交叉点; 2）描述被诊断的概率 在相似的酒精消费水平下，AUD在性别和种族/民族的交叉点之间， 症状;以及3）描述提供者在EHR中选择污名化标签的概率， 基于性别和种族/民族的交叉点诊断AUD。埃利斯先生的职业发展和 指导计划将支持埃利斯先生，因为他发展：1）专业知识和技能，在酒精相关的健康服务 研究和应用差异研究; 2）作为研究者的逐步独立性，表现为在 至少5篇出版物（3篇是第一作者）; 3）申请并获得有竞争力的博士后奖学金，或 F32个人奖学金。埃利斯先生将通过结构化和应用培训实现这些目标， Hallgren博士和布拉德利博士的指导（每周≥3小时），以及4名内容导师的支持。冲击 拟议的补充将告知R33的所有目标，重点是酒精引起的疾病。

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.