Validating NIAAA screening guide in YCMC - administrative supplement

在 YCMC 中验证 NIAAA 筛查指南 - 行政补充

• 批准号: 8710763
• 负责人: SHARON J LEVY
• 金额: $ 5万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-20 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8710763
• 关键词: 16 year old; 18 year old; Accounting; Address; Administrative Supplement; Adolescent; Age; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcohols; Algorithms; Asthma; Blood Glucose; Blood Glucose Self-Monitoring; Boston; Boxing; Budgets; Caring; Categories; Childhood; Chronic; Chronic Disease; Classification; Clinic; Clinical; Complex; Confidence Intervals; Consent; Consumption; Dependence; Diabetes Mellitus; Diagnosis; Diagnostic; Disease; Disease Management; Disease Outcome; Dose; Early identification; Electronics; Environment; Equation; Equilibrium; Food; Frequencies; Friends; Goals; Gold; Health; Health Care Costs; Health Status; Healthcare; Home environment; Instruction; Insulin; Intervention; Interview; Investments; Logic; Logistic Regressions; Measures; Medical; Methods; Modification; Morbidity - disease rate; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Patients; Pediatric Hospitals; Pharmaceutical Preparations; Physicians; Play; Population; Population Study; Predictive Value; Process; Property; Prospective Studies; Quality of life; Recommendation; Regression Analysis; Relative Risks; Reporting; Risk; Risk Factors; Role; Sampling; Screening Result; Self Care; Sensitivity and Specificity; Social Workers; Specific qualifier value; Structure; Students; Testing; Treatment Protocols; Triage; Ulcerative Colitis; Validation; Visit; Youth; adolescent alcohol; alcohol risk; alcohol screening; alcohol use disorder; base; behavioral health; brief alcohol screening; burden of illness; cohort; compliance behavior; cost; depressive symptoms; design; drinking; falls; follow-up; global health; high risk; high school; improved; medical specialist; medical specialties; medication compliance; meetings; neglect; novel strategies; peer; response; screening; social; standard measure; tool; treatment adherence

DESCRIPTION (provided by applicant): Our goal is to validate the NIAAA Guide with youth with chronic medical conditions (YCMC) to facilitate standardized screening and improve the response capability of physicians who regularly interact with them. YCMC are a large and expensive population uniquely vulnerable to harm from drinking given the potential for alcohol to negatively interact with both their underlying health condition and its treatment. We take a novel approach, collecting a battery of assessment information from 400 assented/consented youth (ages 9-18 years) being treated at Children's Hospital Boston for one of four target conditions (asthma, diabetes, a rheumatic disorder or ulcerative colitis; 100 each). Participants will complete an electronic version of the NIAAA guide and an assessment battery comprised of a structured diagnostic interview for alcohol use disorders, a measure of frequency/quantity of alcohol use; a brief interview about friends' use of alcohol and additional brief structured report about medication adherence, quality of life and depressive symptoms. Information on chronic disease status and alcohol risk factors will be obtained via chart review, with input from a team of clinical collaborators with domain expertise in target conditions. Specific Aims are to: Aim 1) validate an NIAAA-Guide based screening algorithm against gold standard measures of alcohol use disorders in the study population, testing the hypothesis that the Guide will yield sensitivity and specificity > .75 for correctly identifying the group of YCMC who have problematic use/ abuse or alcohol dependence. We will use the bootstrap method of re-sampling to estimate 95% confidence intervals about each measure of sensitivity, specificity, and positive and negative predictive values; Aim 2) Evaluate associations between alcohol risk categories established by the NIAAA Guide and measures of other substance use, chronic disease and overall health status and disease management testing hypotheses that (i) Youth with alcohol use problems or disorders will be more likely to use other substances, and will score significantly lower on measures of global health, treatment adherence and chronic disease status, and (ii) consideration of chronic disease- related alcohol risks expands the proportion of youth who fall within the problem use range. We will use Generalized Estimating Equations logistic regression analysis to identify significant differences among those with problem use, abuse and dependence vs. those without on scale scores and other continuous measures of global health and markers of chronic disease status, controlling for moderators and the complex sample design in which participants are nested within clinics and; Aim 3) Develop recommendations for clinician guidance and health messages for inclusion in the Guide for use with YCMC, generated in a modified Delphi process with 20 clinician experts and field tested with patients. Deliverables are a validated, electronic screening tool that triages YCMC into actionable risk groups, contains guidance and examples of field-tested, salient, alcohol related advice, and baseline measures and an initial cohort for a continued prospective study.

描述（由申请人提供）：我们的目标是验证患有患有慢性医疗状况的年轻人（YCMC）的NIAAA指南，以促进标准化的筛查并提高定期与他们互动的医生的反应能力。 YCMC是一个众多且昂贵的人口，鉴于酒精可能与其潜在的健康状况及其治疗造成负面相互作用，因此饮酒的危害很容易受到伤害。我们采用了一种新颖的方法，从400名同意/同意的青年（9-18岁）中收集了一系列评估信息，以解决波士顿儿童医院的四种目标状况之一（哮喘，糖尿病，风湿性疾病或溃疡性结肠炎；每人100）。参与者将填写NIAAA指南的电子版本，并通过对酒精使用障碍的结构化诊断访谈组成的评估电池，这是衡量酒精使用频率/数量的量度；关于朋友使用酒精和其他简短结构化报告的简短采访，内容涉及药物依从性，生活质量和抑郁症状。有关慢性疾病状况和酒精危险因素的信息将通过图表审查获得，并提供了一组目标条件领域专业知识的临床合作者的投入。具体目的是：目标1）验证研究人群中针对酒精使用障碍的黄金标准测量的基于NIAAA的筛查算法，以检验以下假设：该指南将产生敏感性和特异性> .75，以正确识别有问题的使用/滥用/滥用或酒精依赖性的YCMC群体。我们将使用重新采样的自举方法来估计每个敏感性，特异性以及正面和阴性预测值的置信区间的95％置信区间；目的2）评估NIAAA指南确定的酒精风险类别的关联以及其他物质使用，慢性疾病以及整体健康状况和疾病管理测试的措施，即（i）（i）（i）（i）（i）（i）饮酒问题或疾病的青年更有可能使用其他物质，并且将在全球健康，治疗疾病和慢性病中的危险中占据相关性的危险中，将大大降低，并将大大降低。问题使用范围。我们将使用广义估计方程逻辑回归分析来确定存在问题，滥用和依赖性的人之间的显着差异与没有规模得分和其他连续的全球健康状况和慢性疾病状况标记的措施，控制了调节器以及参与者在临床中嵌套的复杂样本设计，并且AIM 3）为临床医生指导和健康信息提供建议，以纳入与YCMC一起使用的指南，并在修改后的Delphi过程中与20位临床专家一起生成，并与患者进行了测试。可交付成果是一种经过验证的电子筛选工具，将YCMC分为可行的风险组，包含指导和示例进行现场测试，显着，酒精相关的建议和基线指标，以及持续前瞻性研究的初始同类。