IAMSBIRT: Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers

IAMSBIRT：在国家儿科创伤中心队列中实施酒精滥用 SBIRT

• 批准号: 10223170
• 负责人: Michael J Mello
• 金额: $ 62.85万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10223170
• 关键词: Address; Adolescent; Adopted; Adoption; Alcohol or Other Drugs use; American College of Surgeons; Analgesics; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Clinical; Computerized Medical Record; Counseling; Data; Data Collection; Development; Drug Screening; Drug usage; Effectiveness; Elements; Feedback; Funding; Goals; Health Personnel; Hospitals; Intervention; Laboratories; Leadership; Mediating; Methods; Nurses; Opioid; Organizational Change; Patients; Pediatric cohort; Performance; Pharmaceutical Preparations; Pharmacotherapy; Provider; Public Health; Recording of previous events; Reporting; Research; Risk; Science; Services; Site; Social Workers; Source; Technology Transfer; Time; Training; Trauma patient; Treatment Protocols; United States Substance Abuse and Mental Health Services Administration; addiction; adolescent patient; alcohol and other drug; alcohol misuse; alcohol screening; alcohol screening and brief intervention; base; brief intervention; care providers; clinical care; cohort; design; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; evidence base; implementation research; implementation science; implementation strategy; implementation study; implementation trial; improved; injured; opioid misuse; organizational readiness; pain patient; patient oriented; pediatric trauma; prescription pain reliever; public health relevance; screening; screening, brief intervention, referral, and treatment; social organization; trauma centers; treatment adherence

PROJECT SUMMARY In 2006, the American College of Surgeons (ACS) adopted a requirement for certification as a level one trauma center that mandated universal screening for alcohol misuse and delivery of a brief intervention for those screening positive. Though this requirement has been mandated for a decade, its implementation has been challenging, especially for pediatric trauma centers. Our research team completed a CDC funded implementation study supporting seven pediatric trauma centers' compliance with the ACS requirement by developing and implementing an institutional alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol for adolescent trauma patients. A mixed-methods approach indicated that SBIRT adoption rates increased at all sites; however, providers' fidelity to the SBIRT intervention was variable, and providers reported a number of barriers to SBIRT implementation. The goal of this application is to conduct a fully powered Type III hybrid effectiveness-implementation trial to test the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug use in pediatric trauma centers. Our implementation strategy is based on the Science to Service Laboratory (SSL), an approach developed by the SAMHSA-funded Addiction Technology Transfer Centers (ATTCs) that consists of the same three core elements (i.e., didactic training + performance feedback + leadership coaching) used in our CDC study. Based on feedback from the CDC study, two enhancements were made to the SSL strategy: 1) integration of the intervention into the electronic medical record as a means of improving SBIRT adherence; and 2) development of separate training tracks for nurses, social workers and organizational leaders to meet the unique needs of each group. In addition, we integrate counseling around the use of prescription pain relievers into the SBIRT intervention as an Exploratory Aim, since most pediatric trauma center patients are discharged on pain medication and patients with a history of AOD use are at elevated risk of opioid misuse. Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers will receive the SSL implementation strategy. Data collection for this study relies on multiple sources. At six distinct time points, each of the 10 sites will provide data from 30 EMR charts (n = 1800 charts in total). A subset of adolescents will also report on fidelity of intervention delivery and linkage to care (i.e., continued AOD discussion and/or treatment with a primary care provider) 1 month post hospital discharge. In addition, nurses, social workers, and leaders from each pediatric trauma center will report on organizational readiness for implementation at three distinct time points. Results of this study will demonstrate that a highly scalable implementation strategy, adapted for pediatric trauma centers from the results of our mixed-methods implementation trial, will improve the fidelity (i.e., the consistency and quality) of SBIRT delivery in pediatric trauma centers.

项目总结 2006年，美国外科医生学会(ACS)通过了一项要求，将其认证为一级创伤 该中心要求对酒精滥用进行普遍筛查，并为这些人提供短暂的干预 筛查呈阳性。虽然这一要求已经强制执行了十年，但它的实施 具有挑战性，特别是对儿科创伤中心来说。我们的研究团队完成了疾控中心资助的 通过以下方式支持七个儿科创伤中心遵守ACS要求的实施研究 制定和实施机构酒精筛查、简短干预和转诊治疗 (SBIRT)青少年创伤患者的治疗方案。一种混合方法的方法表明，SBIRT采用 所有站点的费率都有所上升；然而，提供者对SBIRT干预的忠诚度是可变的，提供者 报告了实施SBIRT的一些障碍。此应用程序的目标是进行一个完整的 动力III型混合动力有效性-实施试验以测试综合 加强儿童酒精及其他药物使用SBIRT的实施策略 创伤中心。我们的实施战略基于科学到服务实验室(SSL)，以及 由SAMHSA资助的成瘾技术转移中心(ATTC)开发的方法，包括 相同的三个核心要素(即教学培训+绩效反馈+领导力培训) 我们疾控中心的研究。根据CDC研究的反馈，对SSL策略进行了两项改进： 1)将干预措施整合到电子病历中，作为提高SBIRT依从性的一种手段； 以及2)为护士、社会工作者和组织领导人制定单独的培训轨道，以满足 每个群体的独特需求。此外，我们还围绕处方止痛药的使用进行咨询 将救援人员纳入SBIRT干预作为探索性目标，因为大多数儿科创伤中心患者 服用止痛药出院和有AOD使用史的患者滥用阿片类药物的风险增加。 利用阶梯形楔形设计，由10个儿科创伤中心组成的全国队列将获得SSL 实施战略。这项研究的数据收集依赖于多种来源。在六个不同的时间点， 这10个站点中的每个站点将提供30张电子病历图表(总共1800张图表)的数据。青少年的一个子集 还将报告干预交付的保真度和与护理的联系(即，继续进行AOD讨论和/或 初级保健提供者的治疗)出院后1个月。此外，护士、社会工作者、 来自每个儿科创伤中心的领导将在以下会议上报告组织实施准备情况 三个不同的时间点。这项研究的结果将表明，一个高度可扩展的实施战略， 从我们混合方法实施试验的结果来看，适用于儿科创伤中心的情况将有所改善 儿科创伤中心SBIRT分娩的保真度(即一致性和质量)。