Latent Classes and Transitions for Brief Alcohol Interventions in Trauma Settings

描述（由申请人提供）：酒精滥用在美国是一个巨大而深远的问题。大多数人不会自行寻求酒精治疗。由于那些滥用酒精的人经常遭受伤害并需要护理，卫生保健专业人员有机会进行筛查并提供简短的干预服务。过去20年的研究表明，酒精筛查和短暂干预（SBI）可以减少使用，伤害再犯和不良驾驶事件。对短暂酒精干预的支持是这样的， 1级创伤中心的认证标准要求SBI提供服务。然而，SBI似乎并不适用于所有受伤的患者。一些SBI试验并没有证明酒精使用或其他伤害风险行为的显着减少。此外，履行机构提供的服务基本上没有资金，提供者只能在没有补偿的情况下筛选和提供干预措施。为了更好地利用履行机构的资源，一种办法可以是将干预针对那些在接受干预后最有可能作出积极改变的人。为了对滥用酒精的受伤患者采用有针对性的方法治疗SBI，了解哪些患者反应最好至关重要。然而，一个有限的了解存在于该领域内，受伤的病人受益最多的SBI。为了确定哪些受伤的患者在一级创伤中心最好的SBI，三个独立的分析将在本论文中进行。分析一和分析二将使用在一级创伤中心进行的RCT的数据进行。第一个分析将使用潜在类分析来识别 基于过去与损伤相关的风险行为的概率患者概况或“类别”。短期干预的益处将通过与损伤相关的风险状况在干预后酒精使用方面的最大减少来衡量。第二项分析将分析患者在接受短暂酒精干预后一年内经历的纵向损伤相关风险行为特征变化。潜在转换分析将用于模拟个体经历的纵向转换，从基线损伤相关风险亚组到其他亚组。分析3将在与1级创伤中心进行的另一项RCT相似但独立的数据集中进行。第三次分析将复制目标1和/或2中开发的模型。在单独的数据集中复制目标1和/或目标2的结果的目的是确定所建立的模型是否可以在第二群体中得到支持。本论文将增加到有限的证据在卫生服务领域就创伤受伤的病人最好的SBI。更好地了解哪些受伤患者对SBI的反应最好，将提高决策者、医疗管理者和临床医生做出潜在必要改变的能力，以提高医疗中心为受伤患者提供SBI服务的有效性和效率。 公共卫生相关性：在美国，酒精滥用是伤害的主要危险因素。卫生保健提供者有很好的机会提供酒精干预个人承认到卫生保健设施的伤害治疗。了解哪些伤害 患者对在卫生保健环境中提供的酒精干预反应最好，这对于有效和高效地利用稀缺的行为健康服务、减少酒精滥用和减少未来的伤害至关重要。

DESCRIPTION (provided by applicant): Alcohol misuse in the United States is a large and far reaching problem. Most individuals do not seek alcohol treatment on their own. Because those who misuse alcohol frequently sustain and need care for injuries, health care professionals have an opportunity to screen and provide brief intervention services. Research over the past 20 years has demonstrated that screening and brief interventions (SBI) for alcohol can reduce use, injury recidivism, and adverse driving events. Support for brief alcohol interventions is such that accreditation standards for Level-1 trauma centers require SBI service delivery. However, SBI does not appear to be effective with all injured patients. A number of SBI trials have not demonstrated significant reductions in alcohol use or other injury risk behaviors. Furthermore, the delivery of SBI services is largely unfunded, and providers are left to screen and provide interventions without compensation. To better utilize SBI resources, one approach could be to target interventions to those who are most likely to make positive changes after receiving interventions. In order to apply a targeted approach for SBI with injured patients who misuse alcohol, knowing which patients respond best is critical. However, a limited understanding exists within the field regarding which injured patients benefit the most from SBI. To identify which injured patients in a Level-1 trauma center respond best to SBI, three separate analyses will be undertaken in this dissertation. Analyses one and two will be conducted using data from a RCT conducted in a Level-1 trauma center. The first analysis will use latent class analysis to identify probabilistic patient profiles or "classes" based on past injury-related risk behaviors. Benefit from the brief intervention will be measured by which injury-related risk profile experienced the greatest reductions in post-intervention alcohol use. The second analysis will analyze the longitudinal injury-related risk behavior profile changes experienced by patients in the year following the receipt of a brief alcohol intervention. Latent transition analysis will be used to model the longitudinal transitions individuals experience from their baseline injury-related risk subgroups into other subgroups across time. Analysis three will be conducted in a similar but separate dataset from another RCT conducted in a Level-1 trauma center. This third analysis will replicate the model(s) developed in Aim 1 and/or 2. The purpose of replicating findings from Aim 1 and/or Aim 2 in a separate dataset is to determine whether the established model(s) can be supported in a second population. This dissertation will add to the limited evidence in the health services field with respect to which traumatically injured patients respond best to SBI. Possessing a greater knowledge of which injured patients respond best to SBI will increase the ability of policymakers, health care administrators, and clinicians to make potentially necessary changes to improve the effectiveness and efficiency of medical centers delivering SBI services to injured patients. PUBLIC HEALTH RELEVANCE: Alcohol misuse is the primary risk factor for injury in the United States. Health care providers have excellent opportunities to deliver alcohol interventions to individuals admitted to health care facilities for injury treatment. Understanding which injured patients respond best to alcohol interventions delivered in health care settings is critical in ordr to effectively and efficiently utilize scarce behavioral health services, decrease alcohol misuse, and reduce future injury.