ANTECEDENT (pArtNerships To Enhance alCohol scrEening, treatment, anD intErveNTion)

项目摘要 酒精滥用是美国第四大死亡原因，也是导致各种疾病的一个因素。 整个生命周期的健康状况。俄勒冈州在不健康酒精的人均成本方面排名全国第八 使用，每年的费用为919美元每俄勒冈人。解决不健康的酒精使用问题需要改进使用 初级保健诊所的变革和组织振兴证据-包括筛查和简短干预（SBI）、药物辅助 治疗（MAT）和转诊治疗（RT）-作为常规护理的一部分。 ANTECEDENT（增强酒精代谢、治疗和干预的技术方案）利用 建立了俄勒冈州农村实践研究网络（ORPRN）和SBIRT俄勒冈州的基础设施 改善俄勒冈州中小型初级保健诊所的SBI和MAT。我们与俄勒冈州 卫生管理局（OHA）转型中心，并使我们的方法与州和地区医疗补助改革保持一致 努力-在2019年1月将包括SBIRT作为电子健康记录报告的质量奖励 公制将利用实践促进作为一项中心和统一战略来提供执行支助。所有 诊所将获得基础支持，包括访问在线实施工具包和6- 为期数月的定制补充支持，旨在通过战略解决临床特定的护理差距 例如促进实践、保健信息技术支助和同侪学习。 我们的实施过程是由一个综合的促进行动的混合概念模型提供信息， 卫生服务研究实施（i-PARIHS）框架和动态可持续性 框架（DSF）。我们使用RE-AIM（覆盖、有效性、采用、实施、维护）来支持 我们的评估。我们的具体目标是：（1）与150名小学生接触、招募和进行入学咨询 护理诊所及其区域CCO在俄勒冈州内;（2）实施并描述如何实践 辅导员根据背景、干预和个人专业知识，使用混合 方法和系统科学;（3）评估基础和补充实施的影响 支持参与的初级保健诊所的SBI、MAT和QI能力。 ANTECEDENT连接改进科学和实施科学-考虑到局部变化和 生产可推广的知识。我们的多方法评估将支持参与外部 评估，并进行强有力的内部评估。ANTECEDENT解决了以下方面的知识差距： 实践促进者的专业知识，并利用国家的情况下，建立初级保健质量指数的能力，并提高履行机构， 不健康的酒精使用。

PROJECT SUMMARY Alcohol misuse is the fourth leading cause of death in the US and a contributing factor to a wide range of health conditions across the lifespan. Oregon state ranks 8th nationally in per capita costs of unhealthy alcohol use, at an annual cost of $919 per Oregonian. Addressing unhealthy alcohol use requires improved use of PCOR evidence in primary care clinics – including screening and brief intervention (SBI), medication assisted treatment (MAT), and referral to treatment (RT) – as part of routine care. ANTECEDENT (pArtNerships To Enhance alCohol scrEening, treatment, anD intErveNTion) leverages the established infrastructure of the Oregon Rural Practice-based Research Network (ORPRN) and SBIRT Oregon to improve SBI and MAT in small to medium sized primary care clinics in Oregon. We partner with the Oregon Health Authority (OHA) Transformation Center and align our approach with state and regional Medicaid reform efforts – which in January 2019 will include SBIRT as an electronic health record reported quality incentive metric. Implementation support will be delivered using practice facilitation as a central and unifying strategy. All clinics will receive Foundational Support which includes access to an online implementation toolkit and 6- months of tailored Supplemental Support designed to address clinic-specific gaps in care through strategies such as practice facilitation, health information technology (HIT) support and peer-to-peer learning. Our implementation process is informed by a hybrid conceptual model of the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Dynamic Sustainability Framework (DSF). We use RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to support our evaluation. Our specific aims are to: (1) Engage, recruit, and conduct intake consultations with 150 primary care clinics and their regional CCOs within the state of Oregon; (2) Implement and describe how practice facilitators tailor implementation support based on context, intervention, and personal expertise using mixed methods and systems science; and (3) Evaluate the impact of foundational and supplemental implementation support on SBI, MAT, and QI capacity in participating primary care clinics. ANTECEDENT bridges improvement science and implementation science – allowing for local change and the production of generalizable knowledge. Our multi-method evaluation will support participation in the external evaluation and enable a robust internal evaluation. ANTECEDENT addresses knowledge gaps regarding practice facilitator expertise and leverages state context to build primary care QI capacity and increase SBI and MAT for unhealthy alcohol use.