AAME: Implementing SBIRT in Patient-Centered Medical Homes

摘要 筛查、短暂干预和转诊治疗（SBIRT）协议的实施表明， 有效减少酒精的使用。然而，在初级保健环境中实施的真实的障碍 存在.以病人为中心的医疗之家（PCMH）是一种初级保健模式，旨在帮助改善人口 健康，降低成本，并为患者提供更好的护理体验。行为服务现在是 PCMH和药物滥用护理是PCMH行为服务的关键要素。初级保健 行为健康（PCBH）模式是将行为保健纳入初级保健的领先模式， 行为健康顾问（BHC）与初级保健提供者（PCP）密切合作。PCMH，尤其是 PCBH有利于SBIRT的实施。 我们建议发展以诊所为基础的酒精滥用管理环境系统， 在PCMH中实施SBIRT的所有阶段。AAME将提供一个优化的，响应用户- 所有设备的经验，并将被设计为帮助实践跟踪和监测患者的进展， 共享临床决策过程，并与内部和外部专业资源协调护理 在整个SBIRT过程中。AAME将与EMR/EHR集成，也有助于满足计费文档要求 Medicare/Medicaid报销要求和PCMH认可要求。 第一阶段的目标包括：1）收集利益相关者对预期系统功能的反馈，感知的有用性， 通过访谈，来自AUD患者和SBIRT提供者和研究人员的采用促进者/障碍; 2） 使用以用户为中心的设计和最新的数字健康技术开发功能原型， 包括FHIR/SMART EMR集成的原型设计;以及3）进行两轮评估研究 患者和供应商。第一轮将是基于设计原型的个人面试， 早期反馈第二轮将是一个为期一周的试点研究，在真实的PCMH设置，以评估系统 可用性、有用性和可接受性。专家小组由以下人员组成： 相关课题的从业人员和研究人员也将被召集，以指导我们的研究和开发 方向

Abstract The implementation of the Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol has shown to be effective in reducing alcohol use. However, real barriers to its implementation in primary care settings exist. The Patient-Centered Medical Home (PCMH) is a primary care model created to help improve population health, lower costs, and give patients better care experiences. Behavioral services are now a core aspect of PCMH, and substance abuse care is a key element of PCMH behavioral services. The Primary Care Behavioral Health (PCBH) model is the leading model integrating behavioral care into primary care with Behavioral Health Consultants (BHCs) working closely with Primary Care Providers (PCPs). PCMH, especially PCBH, is conducive to the implementation of SBIRT. We propose developing the clinic-based Alcohol Abuse Management Environment (AAME) system to facilitate the implementation of all stages of SBIRT in PCMHs. AAME will deliver an optimized, responsive user- experience across all devices and will be designed to help practices track and monitor patient progress, aid the shared clinical decision-making process, and coordinate care with internal and external specialty resources throughout the SBIRT process. AAME will integrate with EMRs/EHRs also help satisfy billing documentation requirements for Medicare/Medicaid reimbursements and PCMH Recognition requirements. Phase I aims include: 1) Collect stakeholder feedback on expected system features, perceived usefulness and adoption facilitators/barriers from AUD patients and SBIRT providers and researchers via interviews; 2) Develop the functional prototype using user-centered design and the latest digital health technologies, including prototyping on FHIR/SMART EMR integration; and 3) Conduct two rounds of the evaluation study with both patients and providers. The first round will be individual interviews based on design prototype for early feedback. The second round will be a one-week pilot study in a real PCMH setting to evaluate system usability, usefulness, and acceptability both qualitatively and quantitatively. An Expert Panel consisting of practitioners and researchers in related topics will also be convened to guide our research and development direction.