Validating NIAAA screening guide in YCMC - administrative supplement

描述(由申请者提供)：我们的目标是验证NIAAA慢性疾病青少年指南(YCMC)，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。YCMC是一个庞大而昂贵的人群，特别容易受到饮酒的伤害，因为酒精可能会对他们潜在的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名在波士顿儿童医院接受治疗的同意/同意的青年(年龄在9-18岁之间)收集了一组评估信息，这些青年正在接受四种目标疾病中的一种(哮喘、糖尿病、风湿性疾病或溃疡性结肠炎；各100例)。参与者将完成NIAAA指南的电子版和一组评估，其中包括对酒精使用障碍的结构化诊断访谈，酒精使用频率/数量的衡量标准；关于朋友饮酒情况的简短访谈，以及关于服药依从性、生活质量和抑郁症状的额外简短结构化报告。有关慢性病状况和酒精风险因素的信息将通过图表审查获得，并由在目标条件下具有领域专业知识的临床合作者团队提供意见。具体目的是：1)对照研究人群中酒精使用障碍的黄金标准标准，验证基于NIAAA指南的筛查算法，测试指南将产生敏感性和特异性的假设，以正确识别有问题的使用/滥用或酒精依赖的YCMC群体。我们将使用重新抽样的Bootstrap方法来估计每项指标的敏感度、特异度以及阳性和阴性预测值的95%可信区间；目的2)评估NIAAA指南确立的酒精风险类别与其他物质使用、慢性病和总体健康状况指标之间的关联，以及疾病管理测试假设：(I)有酒精使用问题或障碍的青少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指标上得分将显著降低，以及(Ii)考虑与慢性疾病相关的酒精风险扩大属于问题使用范围的青少年的比例。我们将使用广义估计方程Logistic回归分析来确定有问题使用、滥用和依赖的人与没有问题使用、滥用和依赖的人之间的显著差异，包括对全球健康和慢性病状态的标记物的量表评分和其他连续测量，控制主持人和参与者嵌套在诊所内的复杂样本设计；目的3)为临床医生指南和健康消息制定建议，以纳入YCMC使用的指南，该指南由20名临床医生专家和患者进行现场测试后生成。可交付成果是一种经过验证的电子筛查工具，可将YCMC分类为可操作的风险组，包含经现场测试的、重要的、与酒精相关的建议和基线措施的指导和实例，以及继续进行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.