K23 Novel Interventions for Alcohol Dependent Frequent ED Users

描述（由申请人提供）：PI，Ryan McCormack，MD，是一名急诊医学医师，其广泛的临床背景和研究经验，包括急诊，内科和成瘾医学的委员会认证，反映了他致力于使用协作，以患者为导向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。他的初步研究主要集中在酒精依赖的频繁急诊科（艾德）用户，一个脆弱的人群，对医疗保健和社会成本的影响不成比例。这些人很难从事他们的个人健康，往往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环境。尽管AUDs普遍存在，但在艾德中很少开始AUDs的治疗，开发和实施有效干预措施的研究更是不常见。McCormack博士采用了一种经过验证的算法来识别这一目标人群，并开发和测试了一种多学科的护理管理（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。他证明了可行性和有希望的结果，包括住房安置和减少艾德和住院病人的使用和死亡率相比，控制。他提出的研究将以缓释纳洛酮（XR-NTX）的形式将有效的药物治疗纳入这种干预。50名受试者将随机接受XR-NTX+CM或标准治疗，这些治疗将在艾德开始，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和大量饮酒的6个月和12个月影响。收集到的关于其交付情况以及流程评价和改进的信息将为随后的有效性实施试验提供信息。这个K23奖将支持麦科马克博士在先进的研究培训和指导，使他能够进行他提出的研究，这将成为R 01应用的基础上，在不同的临床环境中整合酒精治疗的研究。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，并报告调查结果。通过他与几个公共卫生机构，纽约大学的基础设施，以及他的团队经验丰富，有成就的导师，跨越急诊和内科，精神病学，人口健康，麦科马克博士有能力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实践和政策。他的工作的跨学科，协作性质和他的目标“提高服务的有效性，效率和公平性，旨在减少AUD的公共卫生负担”是完全符合NIAAA的使命和愿景。

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.