K23 Novel Interventions for Alcohol Dependent Frequent ED Users

描述（由申请人提供）：PI, Ryan McCormack，医学博士，是一名急诊医生，他具有广泛的临床背景和研究经验，包括急诊，内科和成瘾医学的委员会认证，反映了他致力于通过协作，以患者为导向的方法整合健康服务，以提高酒精使用障碍（AUDs）患者的医疗质量。他的初步研究集中在经常依赖酒精的急诊科（ED）使用者，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。这些人很难关注自己的个人健康，经常只在急诊科接受治疗，而不是在为成瘾和其他慢性疾病提供治疗的机构。尽管AUDs很普遍，但在急诊科很少开始治疗AUDs，开发和实施有效干预措施的研究更少。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，包括住房安置和减少急症和住院病人的使用以及与对照组相比的死亡率。他提出的研究将以缓释纳曲酮（XR-NTX）的形式纳入有效的药物治疗。50名参与者将随机接受XR-NTX+CM或标准治疗，该治疗将在急诊科开始，并通过跨部门和合作机构的协调继续进行。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6个月和12个月对医疗保健利用和酗酒的影响。关于其执行情况以及过程评价和改进所收集的信息将为随后的有效性执行试验提供信息。这个K23奖将支持麦科马克博士进行高级研究培训和指导，使他能够进行他提出的研究，这将构成R01应用研究的基础，该研究将在不同的临床环境中整合酒精治疗。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，并报告研究结果。通过他与几个公共卫生机构的合作，纽约大学的基础设施，以及他的经验丰富和有成就的导师团队，涵盖急诊和内科，精神病学，人口健康，麦科马克博士有能力成为一名独立的研究者，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的协作性质，他的目标是“提高旨在减轻艾滋病患者公共卫生负担的服务的效力、效率和公平性”，这与美国艾滋病研究所的使命和愿景完全一致。

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.