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

项目摘要/摘要 K01指导研究科学家发展奖的长期目标是推动香农博士 史密斯-贝尔纳丁作为专注于新疗法的独立临床医生和研究人员的发展 酒精使用障碍和急性酒精中毒患者的范例。这个拟议的项目有四个 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)定性和混合方法研究；4)补助金撰写。史密斯博士- 贝尔纳丁组建了一个多学科的指导团队，其中包括国家公认的 实施科学、急救医学、酒精使用障碍、弱势群体、频繁使用者 卫生保健、混合方法和定性研究。酒精使用障碍与显著的 世界范围内的发病率和死亡率。在美国，急诊科(ED)和救护车 急救系统(EMS)为酒精中毒患者提供了大部分急诊护理。2%-12%的内科患者 或者精神急诊科的急诊科医生喝得酩酊大醉。“清醒中心”是为满足人们的需求而设计的。 不需要急诊护理的急性无并发症酒精中毒患者，以便这些患者能够 在另一种护理环境中接受安全、高价值的护理。如果使用得当，戒酒中心可以减少 减少急症室就诊的需要，减少急症室的挤迫情况。在目标1中，史密斯-贝尔纳丁博士将描述和定义 醒酒中心、急诊室和急救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 管理数据。在目标2中，她将利用CFIR框架进行和分析深入访谈，以 确定影响急救人员运送急诊患者决策的可修改因素 不复杂的酒精中毒到急诊室而不是清醒中心。这项拟议的研究是第一次： 1)评估具有已建立清醒中心备选方案的社区中的辅助医疗决策；以及2) 招募救护车、急诊室和清醒中心人员，检查现场影响分诊的因素 简单的酒精中毒。这两个目标都将使用创新的实施科学方法来 对EMS、EDS和旧金山清醒中心的健康相关数据进行三角测量。培训和 拟议项目中进行的研究将成为未来R01-Proposal第二类混合试验的基础，以 测试干预措施的实施情况和有效性，以降低供应商和环境水平 变化，以增加对清醒中心的适当使用，并减少对急诊室的依赖 酒精中毒。拟议的项目将为史密斯-贝尔纳丁博士提供必要的支持，使其成为 一位独立的临床医生兼科学家，利用实施科学和混合方法研究开发， 评估和传播针对酒精使用个人的创新的循证治疗范例 精神障碍和急性酒精中毒。

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.