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: 8679111
• 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/8679111
• 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; Commit; Community Hospitals; Comorbidity; Complex; Controlled Clinical Trials; Data; Discipline; Effectiveness; Emergency Department patient; Emergency Medicine; Emergency Situation; 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; Visit; 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.

描述（由申请人提供）：PI Ryan McCormack 医学博士是一名急诊医学医师，拥有广泛的临床背景和研究经验，包括急诊、内科和成瘾医学委员会认证，这反映了他致力于使用协作、以患者为导向的方法整合卫生服务，以提高酒精使用障碍 (AUD) 患者的医疗保健质量。他的初步研究主要集中在急诊室 (ED) 频繁使用酒精依赖的人群，这是一个对医疗保健和社会成本产生不成比例影响的弱势群体。这些人很难关心自己的个人健康，通常只在急诊室接受护理，而不是提供成瘾和其他慢性病治疗的机构。尽管 AUD 很普遍，但急诊室很少开始治疗 AUD，而开发和实施有效干预措施的研究则更少见。 McCormack 博士采用了经过验证的算法来识别这一目标人群，并开发和测试了多学科护理管理 (CM) 干预措施，通过与公共卫生机构合作，利用现有资源协调健康和社会服务。他展示了可行性和有希望的结果，包括与对照组相比，住房安置以及减少急诊室和住院患者的使用和死亡率。他提出的研究将把缓释纳曲酮（XR-NTX）形式的有效药物疗法纳入这种干预措施中。 50 名参与者将被随机分配接受 XR-NTX+CM 或标准护理，该护理将在急诊室启动，并通过跨部门和合作机构的护理协调继续进行。他将评估实施该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和酗酒的 6 个月和 12 个月影响。收集的交付信息以及流程评估和改进将为后续的有效性实施试验提供信息。该 K23 奖项将支持 McCormack 博士进行高级研究培训和指导，使他能够开展拟议的研究，这将构成 R01 应用的基础，该研究将酒精治疗整合到不同的临床环境中。他的职业发展还包括结构化的指导和学徒、全面的教学培训以及参加学术会议、研究小组会议和研究以及报告研究结果。通过与多个公共卫生机构、纽约大学基础设施的合作，以及他在急诊医学、内科医学、精神病学、人口健康领域经验丰富、卓有成就的导师团队，麦考马克博士完全有能力成为一名独立调查员，致力于开发和测试干预模型，并在整个卫生系统传播创新实践和政策。他的工作具有跨学科、协作的性质，他的目标是“提高旨在减轻 AUD 公共卫生负担的服务的有效性、效率和公平性”，这与 NIAAA 的使命和愿景非常一致。