AAME: Implementing SBIRT in Patient-Centered Medical Homes

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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.