Transition to Recovery

过渡到恢复

• 批准号: 10310687
• 负责人: SPERO MARTIN MANSON
• 金额: $ 21.01万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-15 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10310687
• 关键词: Acute; Address; Admission activity; Aftercare; Alaska; Alaska Native; Alcohol consumption; Alcohols; Ambulatory Care; American Indians; Cessation of life; Clinic; Communication; Computerized Medical Record; Cost Effectiveness Analysis; Cost-Benefit Analysis; Data; Drug Metabolic Detoxication; Education; Effectiveness; Enrollment; Ethnic Origin; Evaluation; Failure; Focus Groups; Fostering; General Population; Goals; Health; Healthcare; Healthcare Systems; Homelessness; Impairment; Inpatients; Intervention; Intoxication; Medical; Mental Health; Modeling; Morbidity - disease rate; Mothers; Native-Born; Outcome; Participant; Patients; Pattern; Periodicity; Persons; Population; Predictive Factor; Process; Provider; Race; Randomized; Randomized Controlled Trials; Recovery; Research; Research Project Grants; Resources; Role; Screening for cancer; Severities; Social support; Source; Substance abuse problem; Symptoms; Testing; Time; Training; Transportation; Vulnerable Populations; Withdrawal; Work; addiction; alcohol abuse therapy; alcohol research; alcohol risk; alcohol use disorder; care coordination; cost; cost effective; cost estimate; economic evaluation; economic value; effective intervention; experience; health administration; health disparity populations; high risk; hospital readmission; improved; meetings; mortality; motivational enhancement therapy; outpatient programs; patient oriented; patient population; post intervention; prevent; primary outcome; programs; randomized trial; readmission rates; rural patients; social; treatment program

RESEARCH PROJECT 3 ABSTRACT The primary goal of alcohol detoxification is to medically manage acute intoxication and withdrawal. Its secondary goal of fostering entry into longer-term alcohol treatment post-detoxification is often overlooked. This leads to a revolving door characterized by a cyclical pattern of discharges and readmissions to detoxification. This pattern is observed across the US among alcohol detoxification patients and is even more prevalent among Alaska Native people in Fairbanks where only 2% transition to alcohol treatment following detoxification and approximately 40% are readmitted within 1 year. The revolving door is costly to patients and providers. Current estimates associated with the cost of detoxification are not available. A study over 25 years ago indicated the average inpatient detoxification stay was over $3,300. Although the Substance Abuse and Mental Health Administration recognizes that better linkages are needed to transition people to treatment following detoxification, few interventions have tested ways to improve this transition; none of these prior studied included either Alaska Natives or American Indians. In partnership with the Fairbanks Native Association’s Gateway to Recovery (GTR), we propose to use patient navigators to guide and assist patients in transitioning to appropriate levels of treatment, and to help eliminate barriers that obstruct treatment entry. Our study first uses GTR’s electronic medical record data to identify factors that predict transition to treatment and readmission to detoxification among ~1,000 patients seen over the prior 5 years. Second, we will use this information, combined with focus groups comprised of key stakeholders, to identify appropriate navigator roles and processes for alcohol detoxification patients. We will then conduct a randomized controlled trial of the modified intervention with 700 patients. Third, we will estimate the costs of implementing and sustaining this intervention, Transition to Recovery, as well as its economic value. Our control condition will include 1 session of motivational interviewing that will include goal setting and strategies to reduce alcohol consumption after detoxification discharge. Our Specific Aims are to: 1) Use electronic medical record data from ~1,000 patients to identify factors associated with post-detoxification transition to alcohol treatment and readmission to detoxification; 2) Adapt Transition to Recovery to fit the GTR patient population and test its effectiveness in increasing transition to post-detoxification treatment within 30 days and prevent readmission within 1 year; and 3) Perform a comprehensive economic evaluation of Transition to Recovery by using cost-benefit and cost- effectiveness analyses. This is the first randomized controlled intervention to use patient navigators to enhance transition to alcohol treatment following detoxification. If effective, this intervention may be a cost-effective means of transitioning detoxification patients to treatment across health care systems nationally.

研究项目 3 摘要 酒精解毒的主要目标是通过医学手段控制急性中毒和戒断症状。它是 促进戒毒后进入长期酒精治疗的次要目标常常被忽视。 这导致了旋转门的特点是循环模式的放电和重新接纳 排毒。在美国各地的酒精戒毒患者中都观察到这种模式，甚至更严重 在费尔班克斯的阿拉斯加原住民中流行，只有 2% 的人在接受酒精治疗后 戒毒，大约 40% 的人在 1 年内重新入院。旋转门对患者来说成本高昂 提供商。目前无法获得与戒毒费用相关的估计。一项超过25年的研究 此前表明，平均住院戒毒费用超过 3,300 美元。尽管药物滥用和 精神卫生管理局认识到需要更好的联系来帮助人们接受治疗 戒毒后，很少有干预措施测试过改善这种转变的方法；这些之前都没有 研究对象包括阿拉斯加原住民或美洲印第安人。与费尔班克斯本地人合作 协会的康复之门 (GTR)，我们建议使用患者导航器来指导和协助患者 过渡到适当水平的治疗，并帮助消除阻碍治疗的障碍。我们的 研究首先使用 GTR 的电子病历数据来确定预测治疗过渡的因素， 过去 5 年中约 1,000 名患者再次入院戒毒。其次，我们将使用这个 信息与主要利益相关者组成的焦点小组相结合，以确定适当的引导者角色 以及酒精戒毒患者的流程。然后我们将进行一项随机对照试验 对 700 名患者进行了改良干预。第三，我们将估算实施和维持这一计划的成本 干预、向复苏过渡及其经济价值。我们的控制条件将包括 1 个会话 动机访谈，其中包括目标设定和减少饮酒后的策略 排毒排出。我们的具体目标是： 1) 使用约 1,000 名患者的电子病历数据 确定与戒毒后过渡到酒精治疗和重新入院相关的因素 排毒； 2) 调整过渡到恢复以适应 GTR 患者群体并测试其有效性 在 30 天内增加向戒毒后治疗的过渡，并在 1 年内防止再次入院；和 3) 利用成本效益和成本效益对向复苏过渡进行全面的经济评估 有效性分析。这是第一个使用患者导航器来增强的随机对照干预措施 戒毒后过渡到酒精治疗。如果有效，这种干预措施可能是一种具有成本效益的方法 将戒毒患者过渡到全国医疗保健系统治疗的方法。