Disseminating Organizational SBI Services (DO-SBIS) at Trauma Centers

在创伤中心传播组织 SBI 服务 (DO-SBIS)

• 批准号: 7319475
• 负责人: DOUGLAS F ZATZICK
• 金额: $ 70.89万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7319475
• 关键词: Accident and Emergency department; Acute; Admission activity; Adoption; Alcohol consumption; Alcohols; American College of Surgeons; Baseline Surveys; Caring; Climate; Condition; Data; Development; Educational workshop; Equipment and supply inventories; Feedback; Funding; Future; Goals; Health Services Research; Healthcare; Hospitals; Individual; Injury; Inpatients; Interdisciplinary Study; Intervention; Investigation; Left; Medical; Methodology; Numbers; Operative Surgical Procedures; Outcome; Outpatients; Patients; Phase; Policies; Primary Health Care; Procedures; Provider; Public Health; Randomized; Randomized Clinical Trials; Readiness; Research Personnel; Resolution; Risk; Screening procedure; Services; Site; Standards of Weights and Measures; Statistically Significant; Surveys; Telephone; Time; Training; Trauma; United States; Writing; alcohol services; alcohol use disorder; base; dissemination trial; early /brief intervention /therapy; follow-up; improved; injured; motivational enhancement therapy; programs; response; therapy development; trauma centers

DESCRIPTION (provided by applicant): Each year in the United States approximately 2.5 million individuals are so severely injured that they require inpatient hospital admission. The integration of screening and brief interventions (SBI) into acute injury care has the potential to markedly increase the number of patients who receive needed services and has been a longstanding public health objective. In January of 2005 the American College of Surgeons, the primary agency responsible for developing trauma center requirements, passed a landmark resolution mandating that level I trauma centers must screen injured patients for an alcohol use disorder, and provide an intervention to those who screen positive. Preliminary studies suggest that there is a substantial risk that the SBI mandate will be implemented with marked variability and that low quality SBI procedures could become the default standard of trauma center care. The goal of the Disseminating Organizational Screening and Brief Interventions Services (DO-SBIS) investigation is to capitalize on the unique opportunity afforded by the American College of Surgeons' mandate by taking early steps to insure high quality, evidence-based SBI services are implemented and outcomes are assessed. In the first phase of the investigation, SBI services will be assessed for all 190 level I trauma centers in the United States. In the second phase of the investigation, 20 level I trauma centers will be selected for randomization to intervention or control conditions. Providers at each intervention trauma center will receive workshop training and ongoing telephone coaching in the delivery of evidence-based motivational interviewing (Ml) intervention; Ml training will be embedded within evidence-based organizational development activities that aim to facilitate the integration of SBI services into routine trauma center care. Control trauma centers will implement SBI care as usual. The investigation hypothesizes that intervention trauma centers, when compared to control trauma centers, will demonstrate higher quality SBI, as evidenced by greater provider proficiency in SBI delivery, significant reductions in 6- and 12-month post-injury alcohol use in patients receiving SBI, and enhanced organizational acceptance of SBI services. Without DO-SBIS baseline data on SBI services and follow-up RCT data on patient, provider, and organizational outcomes, a critical opportunity to provide empiric support of a historic policy decision to require alcohol services at level I trauma centers could be lost. The DO-SBIS interdisciplinary research group includes trauma surgery opinion leaders who are dedicated to implementing future policy mandates that derive from the DO-SBIS research program. Future mandates will aim to strengthen and refine trauma center delivery of evidence-based SBI services. The dissemination of high quality SBI services at level I trauma centers has the potential to influence alcohol policy in other health care settings nationwide.

描述（由申请人提供）：在美国，每年大约有 250 万人受到严重伤害，需要住院治疗。将筛查和简短干预 (SBI) 纳入急性损伤护理有可能显着增加接受所需服务的患者数量，并且一直是一个长期的公共卫生目标。 2005 年 1 月，负责制定创伤中心要求的主要机构美国外科医生学会通过了一项具有里程碑意义的决议，要求一级创伤中心必须对受伤患者进行酒精使用障碍筛查，并对筛查结果呈阳性的患者提供干预。初步研究表明，SBI 指令的执行存在显着的可变性，并且低质量的 SBI 程序可能成为创伤中心护理的默认标准。传播组织筛查和简短干预服务 (DO-SBIS) 调查的目标是利用美国外科医生学会的使命提供的独特机会，采取早期措施，确保实施高质量、基于证据的 SBI 服务并评估结果。在调查的第一阶段，将对美国所有 190 个一级创伤中心的 SBI 服务进行评估。在第二阶段的调查中，将随机选择20个一级创伤中心进行干预或控制病情。每个创伤干预中心的提供者将接受研讨会培训和持续的电话辅导，以提供基于证据的动机访谈（ML）干预； ML 培训将嵌入基于证据的组织发展活动中，旨在促进 SBI 服务整合到常规创伤中心护理中。创伤控制中心将照常实施 SBI 护理。该调查假设，与控制创伤中心相比，干预创伤中心将表现出更高质量的 SBI，这可以通过提供者在 SBI 交付方面的熟练程度更高、接受 SBI 的患者受伤后 6 个月和 12 个月的饮酒量显着减少以及组织对 SBI 服务的接受度提高来证明。如果没有关于 SBI 服务的 DO-SBIS 基线数据以及关于患者、提供者和组织结果的后续 RCT 数据，则可能会失去为一级创伤中心要求酒精服务的历史性政策决策提供经验支持的关键机会。 DO-SBIS 跨学科研究小组包括创伤外科意见领袖，他们致力于实施源自 DO-SBIS 研究计划的未来政策任务。未来的任务将旨在加强和完善创伤中心提供基于证据的 SBI 服务。在一级创伤中心传播高质量的 SBI 服务有可能影响全国其他医疗机构的酒精政策。