Validating NIAAA screening guide in YCMC - administrative supplement

描述（由申请人提供）：我们的目标是验证NIAAA指南与青年与慢性疾病（YCMC），以促进标准化的筛选和提高响应能力的医生谁经常与他们互动。YCMC是一个庞大而昂贵的人口，特别容易受到饮酒的伤害，因为酒精有可能与他们的基本健康状况及其治疗产生负面影响。我们采取了一种新的方法，从400名同意/同意的青少年（年龄9-18岁）中收集了一组评估信息，这些青少年在波士顿儿童医院接受四种目标疾病（哮喘，糖尿病，风湿性疾病或溃疡性结肠炎;各100人）之一的治疗。参与者将完成NIAAA指南的电子版本和评估电池，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;关于朋友使用酒精的简短访谈和关于药物依从性，生活质量和抑郁症状的其他简短结构化报告。将通过图表审查获得有关慢性疾病状态和酒精风险因素的信息，并从具有目标条件领域专业知识的临床合作者团队获得输入。具体目标是：目的1）针对研究人群中酒精使用障碍的金标准测量，验证基于NIAAA指南的筛查算法，测试指南将产生> .75的灵敏度和特异性的假设，以正确识别具有问题使用/滥用或酒精依赖的YCMC组。我们将使用重新抽样的bootstrap方法来估计敏感性、特异性、阳性和阴性预测值的95%置信区间;目的2）评估由NIAAA指南建立的酒精风险类别与其他物质使用措施之间的关联，慢性病和整体健康状况和疾病管理测试假设，（i）有酒精使用问题或障碍的青年将更有可能使用其他物质，并且在全球健康、治疗依从性和慢性病状况方面的得分将显著降低，及（ii）考虑到与慢性疾病有关的酒精风险，会增加青少年在问题饮酒范围内的比例。我们将使用广义估计方程逻辑回归分析，以确定那些有问题的使用，滥用和依赖与那些没有量表分数和其他全球健康和慢性病状态标志物的连续测量的显着差异，控制调节因子和复杂的样本设计，其中参与者嵌套在诊所内;目标3）为临床医生指导和健康信息制定建议，以纳入YCMC使用的指南中，由20名临床医生专家在修改后的德尔菲过程中生成，并在患者中进行现场测试。可识别性是一种经过验证的电子筛选工具，可将YCMC分类为可操作的风险组，包含经过现场测试的指导和示例，突出的酒精相关建议，以及基线测量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.