K23 Novel Interventions for Alcohol Dependent Frequent ED Users

K23 针对酒精依赖频繁 ED 用户的新颖干预措施

• 批准号: 8924894
• 负责人: Ryan P McCormack
• 金额: $ 18.44万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-10 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8924894
• 关键词: Accident and Emergency department; Accounting; Acute; Address; Alcohol consumption; Alcohol dependence; Alcohols; Algorithms; Ambulances; Ambulatory Care; Behavior Therapy; Board Certification; Caring; Case Management; Cessation of life; Chronic; Clinical; Collaborations; Community Hospitals; Comorbidity; Complex; Controlled Clinical Trials; Data; Discipline; Effectiveness; Emergency Department patient; Emergency Medicine; Emergency Situation; Emergency department visit; Enrollment; Evaluation; Feasibility Studies; Future; Group Meetings; Health; Health Care Costs; Health Care Visit; Health Services; Health system; Healthcare; Heavy Drinking; High Prevalence; Home environment; Homelessness; Hospital Departments; Housing; Individual; Inpatients; Institution; Intake; Internal Medicine; Intervention; Intervention Trial; Intoxication; Measures; Medical; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Mission; Modeling; Naltrexone; National Institute on Alcohol Abuse and Alcoholism; Nature; Outcome; Outpatients; Participant; Patient Outcomes Assessments; Patients; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacotherapy; Physicians; Policies; Population; Positioning Attribute; Preparation; Prevalence; Process; Psychiatry; Psychosocial Influences; Public Health; Randomized; Recruitment Activity; Reporting; Research; Research Design; Research Infrastructure; Research Personnel; Research Training; Resources; Services; Social Health Services; Social Work; Societies; Structure; System; Target Populations; Testing; Training; Training Programs; Vision; Vulnerable Populations; Work; addiction; administrative database; alcohol abuse therapy; alcohol use disorder; base; care seeking; career; career development; cost; design; drinking; effective intervention; effectiveness trial; experience; flexibility; follow-up; health care delivery; health care quality; health care service utilization; implementation trial; improved; information gathering; innovation; intervention effect; mortality; multi-component intervention; multidisciplinary; novel; patient oriented; patient population; population health; psychosocial; public health relevance; research study; response; screening; social; standard care; success; supported housing; symposium

DESCRIPTION (provided by applicant): The PI, Ryan McCormack, MD, is an emergency medicine physician whose broad clinical background and research experience, including board certification in Emergency, Internal, and Addiction Medicine, reflects his commitment to integrating health services using collaborative, patient-oriented approaches to enhance healthcare quality for individuals with alcohol use disorders (AUDs). His preliminary research has focused on alcohol dependent frequent emergency department (ED) users, a vulnerable population that has a disproportionate impact on healthcare and societal costs. These individuals are difficult to engage in their personal health and often receive care exclusively in EDs, rather than settings offering treatment for addiction and other chronic conditions. Despite its prevalence, treatment for AUDs is rarely initiated in the ED, and research to develop and implement effective interventions is even less common. Dr. McCormack adapted a validated algorithm to identify this target population and developed and tested a multidisciplinary, care management (CM) intervention that coordinates health and social services using existing resources through collaboration with public health agencies. He demonstrated feasibility and promising outcomes, including housing placement and reduced ED and inpatient use and mortality compared to controls. His proposed research will incorporate efficacious pharmacotherapy in the form of extended-release naltrexone (XR-NTX) to this intervention. Fifty participants will be randomized to receive XR-NTX+CM or standard care, which will be initiated in the ED and continued through coordination of care across departments and partnering agencies. He will assess feasibility and acceptability of implementing this intervention and of rigorously testing its 6- and 12- month effect on healthcare utilization and heavy drinking. Information gathered on its delivery as well as process evaluations and refinements will inform subsequent effectiveness-implementation trials. This K23 award will support Dr. McCormack in advanced research training and mentoring, allowing him to conduct his proposed research, which will form the basis for an R01 application on studies that integrate alcohol treatment in diverse clinical settings. His career development also includes structured mentorship and apprenticeships, comprehensive didactic training, as well as participation in academic conferences, research group meetings and studies, and reporting findings. Through his partnership with several public health agencies, the infrastructure of NYU, and his team of experienced and accomplished mentors that span emergency and internal medicine, psychiatry, population health, Dr. McCormack is well-positioned to become an independent investigator committed to developing and testing models of intervention and disseminating innovative practices and policies across health systems. The trans-disciplinary, collaborative nature of his work and his aim "to improve the effectiveness, efficiency and equity of services designed to reduce the public health burden of AUDs" are well aligned with the Mission and Vision of NIAAA.

简介(由申请人提供)：该私人助理Ryan McCormack医学博士是一名急诊内科医生，他具有广泛的临床背景和研究经验，包括急诊、内科和成瘾医学的董事会认证，这反映了他致力于通过协作性的、以患者为中心的方法整合医疗服务，以提高酒精使用障碍(AUD)患者的医疗质量。他的初步研究重点是酒精依赖频繁的急诊科(ED)使用者，这是一个弱势群体，对医疗保健和社会成本有不成比例的影响。这些人很难保持个人健康，往往只在急诊室接受护理，而不是在提供成瘾和其他慢性病治疗的环境中接受护理。尽管AUDS很普遍，但急诊科很少开始治疗AUDS，开发和实施有效干预措施的研究就更不常见了。McCormack博士采用了一种经过验证的算法来确定这一目标人群，并开发和测试了一种多学科护理管理(CM)干预措施，通过与公共卫生机构的合作，利用现有资源协调卫生和社会服务。他展示了可行性和有希望的结果，包括住房安置和与对照组相比减少ED和住院患者的使用和死亡率。他提议的研究将把以缓释纳曲酮(XR-NTX)形式的有效药物疗法纳入到这一干预中。50名参与者将随机接受XR-NTX+CM或标准护理，这将在急诊室启动，并通过协调各部门和合作机构的护理继续进行。他将评估实施这一干预措施的可行性和可接受性，并严格测试其对医疗保健利用率和酗酒的6个月和12个月的影响。收集到的关于其交付情况的信息以及程序评价和改进将为随后的有效性执行试验提供信息。这项K23奖项将支持McCormack博士进行高级研究培训和指导，使他能够进行他提议的研究，这将成为R01申请在不同临床环境中整合酒精治疗的研究的基础。他的职业发展还包括有组织的导师和学徒制度，全面的教学培训，以及参与学术会议、研究小组会议和研究，以及报告研究结果。通过与几家公共卫生机构、纽约大学的基础设施以及他的经验丰富和成就卓著的导师团队的合作，麦科马克博士的团队涵盖了急诊和内科、精神病学、人口健康，他已经处于有利地位，可以成为一名独立的调查员，致力于开发和测试干预模式，并在卫生系统中传播创新的做法和政策。他的工作具有跨学科、协作性的性质，他的目标是“提高旨在减轻AUDS公共卫生负担的服务的效力、效率和公平性”，这与NIAAA的使命和愿景非常一致。