Evaluation of paramedic decision making in triage and transport of adults with acute uncomplicated alcohol intoxication to the emergency department versus sobering center

项目总结/摘要 这个K 01指导研究科学家发展奖的长期目标是推进香农博士 Smith-Bernardin作为一名专注于新型治疗的独立临床研究者的发展 酒精使用障碍和急性酒精中毒患者的范例。该项目有四个 培训目标：高级培训：1）实施科学; 2）获取，合并和分析 行政数据; 3）定性和混合方法的研究;和4）赠款写作。史密斯博士- Bernardin组建了一个多学科的导师团队，包括国家认可的专家， 实施科学，急救医学，酒精使用障碍，弱势群体，频繁使用者 医疗保健，混合方法和定性研究。酒精使用障碍与显著的 发病率和死亡率。在美国，急诊室（ED）和救护车 EMS系统（EMS）为酒精中毒提供了大部分紧急护理。2-12%的患者在医疗 或者精神科急诊室的人都是急性中毒“清醒中心”是为了满足人们的需求 急性无并发症酒精中毒，不需要艾德护理，因此这些人可以 在替代性护理环境中接受安全、高价值的护理。如果使用得当，清醒中心可以减少 艾德就诊的需要，并减少艾德过度拥挤。在目标1中，Smith-Bernardin博士将描述和定义 清醒中心、艾德和EMS系统中急性酒精中毒患者的发生率， 比较影响运输决策的患者、提供者和环境因素， 行政数据。在目标2中，使用CFIR框架，她将进行和分析深入访谈， 确定影响救护人员决定运送急性呼吸道感染病人的可修改因素 单纯性酒精中毒而不是戒酒中心的艾德拟议的研究是第一个： 1)评估护理人员在社区中的决策，并建立清醒中心替代方案;以及2） 招募救护车、艾德和清醒中心人员，检查影响现场分诊的因素， 单纯性酒精中毒这两个目标都将使用创新的实施科学方法， 对EMS、ED和旧金山弗朗西斯科戒酒中心的健康相关数据进行三角测量。培训和 在拟议项目中进行的研究将构成未来R 01-提案混合动力II型试验的基础， 测试干预措施的实施和有效性，以降低供应商和环境水平 变化，以增加清醒中心的适当使用，并减少对艾德急性 酒精中毒拟议的项目将为史密斯-伯纳丁博士提供必要的支持， 一个独立的临床医生，科学家使用实施科学和混合方法研究开发， 评估和传播创新的，以证据为基础的治疗模式，为个人与酒精使用 急性酒精中毒。

PROJECT SUMMARY/ ABSTRACT The long-term goal of this K01 Mentored Research Scientist Development Award is to advance Dr. Shannon Smith-Bernardin's development as an independent clinician-investigator focusing on novel treatment paradigms for people with alcohol-use disorders and acute alcohol intoxication. This proposed project has four training aims: advanced training in: 1) implementation science; 2) obtaining, merging and analyzing administrative data; 3) qualitative and mixed-methods research; and 4) grant writing. Dr. Smith- Bernardin has assembled a multi-disciplinary mentorship team including nationally recognized experts in implementation science, emergency medicine, alcohol use disorders, vulnerable populations, frequent utilizers of health care, mixed methods, and qualitative research. Alcohol use disorders are associated with significant morbidity and mortality worldwide. In the United States, emergency departments (EDs) and the ambulance system (EMS) provide the majority of acute care for alcohol intoxication. Between 2-12% of patients in medical or psychiatric EDs are acutely intoxicated. “Sobering centers” were designed to address the needs of people with acute uncomplicated alcohol intoxication who do not require ED care, so that these individuals could receive safe, high value care in an alternative care setting. If used appropriately, sobering centers can reduce the need for ED visits and reduce ED overcrowding. In Aim 1, Dr. Smith-Bernardin will characterize and define the incidence of patients with acute alcohol intoxication in the Sobering Center, the ED, and EMS system and compare the patient, provider, and environmental-level factors that influence the transport decision using administrative data. In Aim 2, using the CFIR framework, she will conduct and analyze in-depth interviews to determine modifiable factors influencing ambulance personnel's decision to transport patients with acute uncomplicated alcohol intoxication to an ED instead of the Sobering Center. The proposed study is the first to: 1) evaluate paramedic decision making in a community with an established sobering center alternative; and 2) recruit ambulance, ED, and Sobering Center personnel to examine the factors affecting triage in the field for uncomplicated alcohol intoxication. Both aims will use innovative implementation science methods to triangulate health related data from EMS, EDs, and the San Francisco Sobering Center. The training and research conducted in the proposed project will form the basis of a future R01-proposal hybrid type II trial to test the implementation and effectiveness of an intervention to reduce provider and environmental level variation in order to increase of appropriate use of sobering centers and reduce reliance on the ED for acute alcohol intoxication. The proposed project will provide Dr. Smith-Bernardin the support necessary to become an independent clinician-scientist using implementation science and mixed-methods research to develop, evaluate, and disseminate innovative, evidence-based treatment paradigms for individuals with alcohol-use disorders and acute alcohol intoxication.