Validating NIAAA screening guide in YCMC - administrative supplement

描述（由申请人提供）：我们的目标是在患有慢性疾病（YCMC）的青年中验证NIAAA指南，以促进标准化筛查并提高定期与他们互动的医生的反应能力。由于酒精可能对他们潜在的健康状况和治疗产生负面影响，YCMC是一个庞大而昂贵的人群，特别容易受到饮酒的伤害。我们采用了一种新颖的方法，收集了400名在波士顿儿童医院接受治疗的同意/同意的青少年（9-18岁）的一系列评估信息，这些青少年患有四种目标疾病（哮喘、糖尿病、风湿性疾病或溃疡性结肠炎；每种100人）。参与者将完成NIAAA指南的电子版和一组评估，包括酒精使用障碍的结构化诊断访谈，酒精使用频率/数量的测量；一个关于朋友使用酒精的简短访谈，以及关于药物依从性、生活质量和抑郁症状的简短结构化报告。慢性病状况和酒精危险因素的信息将通过图表审查获得，并由具有目标条件领域专业知识的临床合作者小组提供意见。具体目的是：目的1)验证基于niaaa指南的筛选算法，以对照研究人群中酒精使用障碍的金标准措施，验证该指南在正确识别有问题使用/滥用或酒精依赖的YCMC群体方面的敏感性和特异性为bb0.75的假设。我们将使用重新抽样的自举方法来估计灵敏度、特异性和阳性和阴性预测值的每个测量值的95%置信区间；目标2)评估NIAAA指南确定的酒精风险类别与其他物质使用、慢性疾病和总体健康状况以及疾病管理措施之间的关联，检验以下假设：(i)有酒精使用问题或失调的青年更有可能使用其他物质，并且在全球健康、治疗依从性和慢性疾病状况方面得分明显较低；（ii）考虑到与慢性疾病相关的酒精风险，扩大了属于问题使用范围的青年的比例。我们将使用广义估计方程逻辑回归分析来识别有问题使用、滥用和依赖的人与没有问题使用、滥用和依赖的人在量表得分和其他全球健康和慢性疾病状态标记的连续测量上的显著差异，控制调节因子和复杂的样本设计，其中参与者嵌套在诊所和；目标3)制定临床医生指导和健康信息的建议，以纳入YCMC使用的指南，由20名临床医生专家通过改进的德尔菲过程产生，并与患者进行现场测试。交付成果是一个经过验证的电子筛选工具，将YCMC分类到可操作的风险组，包含指导和现场测试的例子，突出的，酒精相关的建议，基线措施和持续前瞻性研究的初始队列。

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.