The Michigan Sustained Patient-centered Alcohol-Related Care (MI-SPARC) Trial

密歇根州持续以患者为中心的酒精相关护理 (MI-SPARC) 试验

• 批准号: 10259683
• 负责人: KATHARINE ANTHONY BRADLEY
• 金额: $ 69.07万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10259683
• 关键词: Michigan; Sustained; Patient; centered; Alcohol

Project Summary. Unhealthy alcohol use is a major contributor to morbidity and mortality in the US. Although effective prevention for unhealthy alcohol use and medication treatment for alcohol use disorders (AUDs) can be provided in primary care (PC), they have historically not been included in routine services. As a result, most patients do not receive evidence-based prevention or treatment for unhealthy alcohol use. Several efforts have successfully implemented alcohol-related preventive care—referred to as screening and brief intervention (SBI), but efforts to increase treatment of AUDs with medications have been less successful. Moreover, implementation efforts have usually neglected smaller PC practices, in which most PC is provided. The proposed project is a partnership between Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle, bringing extensive expertise implementing evidence-based alcohol-related care, and Altarum Institute in Ann Arbor, Michigan, bringing demonstrated success engaging over 500 small to medium Michigan-based PC practices in effective quality improvement (QI) efforts. The project builds on Altarum's innovative approach to implementing new or improved clinical care such as depression screening, oral healthcare, or safer opioid prescribing in PC. Altarum's approach uses practice facilitators to provide continuing medical education and maintenance of certification (CME/MOC) programs to PC providers, along with ongoing support for QI using evidence-based implementation strategies. The KPWHRI team recently finished the highly successful AHRQ-funded Sustained Patient-centered Alcohol-Related Care (SPARC) trial using similar implementation strategies in KP Washington, and also developed a patient decision aid to support shared decision-making between patients with high-risk drinking and/or AUDs and their PC providers. The proposed Michigan SPARC (MI-SPARC) trial combines Altarum's expertise in QI in small-medium PC practices in Michigan with KPWHRI's expertise implementing evidence-based prevention and treatment of unhealthy alcohol use—specifically alcohol SBI and medication treatment for AUDs, sometimes called MAT, for “medication-assisted therapy”. Specific Aims of the MI-SPARC trial are to: 1. Test whether the MI-SPARC model increases (a) alcohol SBI and/or (b) initiation of medication treatment for AUDs, in small to medium PC practices in Michigan, in a stepped-wedge trial with 6 waves, and 2. Test whether adding an innovative decision aid for AUDs to MI-SPARC implementation increases rates of (a) SBI, and/or (b) initiation of medication treatment for AUDs, in a nested two-arm cluster randomized trial. Public Health Impact. Despite consolidation of PC into large systems, 58% of PC in the US is still provided by small-medium practices. Decreasing morbidity and mortality of unhealthy alcohol use therefore requires adapting and testing approaches to improving alcohol-related care in these PC practices. The MI-SPARC team is uniquely qualified to lead such an effort, in collaboration with AHRQ's national evaluation.

项目摘要。不健康的酒精使用是美国发病率和死亡率的主要原因。 虽然有效的预防不健康的酒精使用和药物治疗酒精使用障碍 虽然AUD可以在初级保健（PC）中提供，但它们历来不包括在常规服务中。作为 因此，大多数患者没有接受基于证据的预防或治疗不健康的酒精使用。几 努力成功地实施了与酒精有关的预防性护理--称为筛查和简短的 然而，目前的研究已经证实，药物干预（SBI）是有效的，但增加药物治疗AUD的努力不太成功。 此外，执行工作通常忽略了提供大部分PC的较小PC实践。 拟议中的项目是凯撒永久华盛顿健康研究所 （KPWHRI）在西雅图，带来了广泛的专业知识，实施循证酒精相关护理， Altarum研究所在密歇根州安阿伯，带来了成功的证明，吸引了500多个中小型企业 在有效的质量改进（QI）工作中，以密歇根州为基础的PC实践。该项目建立在Altarum的 实施新的或改进的临床护理的创新方法，如抑郁症筛查、口腔 医疗保健或PC中更安全的阿片类药物处方。Altarum的方法使用实践促进者来提供持续的 向PC提供商提供医学教育和认证维护（CME/MOC）计划，沿着正在进行的 使用基于证据的实施战略支持QI。KPWHRI团队最近完成了高度 成功的AHRQ资助的持续的以患者为中心的酒精相关护理（SAH）试验，使用类似的 在KP华盛顿实施战略，并制定了一个病人的决策援助，以支持共享 高风险饮酒和/或AUD患者与其PC提供商之间的决策。 拟议中的密歇根大学（MI-MIT）试验结合了Altarum在中小型PC QI方面的专业知识 在密歇根州的实践与KPWHRI的专业知识实施循证预防和治疗 不健康的酒精使用，特别是酒精SBI和药物治疗AUD，有时称为MAT， “药物辅助治疗”MI-试验的具体目的是： 1.测试MI-模型是否增加（a）酒精SBI和/或（B）药物治疗的开始 对于AUD，在密歇根州的中小型PC实践中，在6波阶梯楔形试验中，以及 2.测试在MI-100实施中添加AUD的创新决策辅助是否会增加 (a)SBI，和/或（B）在一项嵌套双臂随机分组试验中开始AUD药物治疗。 公共卫生影响。尽管PC整合到大型系统中，但美国58%的PC仍由 中小企业实践。因此，减少不健康饮酒的发病率和死亡率需要 调整和测试方法，以改善这些PC实践中与酒精相关的护理。MI团队 在与AHRQ的国家评估合作下，