INtervention in Small Primary care practices to Implement Reduction in unhealthy alcohol usE (INSPIRE)

摘要 不健康的饮酒是可预防死亡的主要原因，也是一系列社会和心理疾病的风险因素 健康问题，估计每年对经济的影响为2490亿美元。尽管重大的公共卫生问题 由于不健康饮酒的影响，全国的筛查率仍然很低。在伊利诺斯州和威斯康星州， 中西部两个不健康饮酒水平最高的州，只有不到17%的患者 在初级保健环境中进行筛查，报告使用大量酒精的患者中只有5%接受了治疗。 在小实践中有效的筛查和治疗受到缺乏关于筛查的临床医生教育的限制 和管理，酒精使用障碍的低处方率，转诊的可得性很差 项目，以及将干预措施整合到现有临床工作流程中的困难。基于清单的筛查 工具提供了一种简单、易于理解的策略，并已在医疗保健中成功应用 布景。在这个项目中，我们旨在测试基于办公室的筛查的可行性和有效性，该项目由 初级保健实践中基于行为和药物的干预，通过 教育、实践促进和嵌入式电子病历技术。该项目汇集了一个互补的 来自学术机构、质量改进组织、以实践为基础的研究的专家团队 网络和独立研究组织，其中大多数以前曾合作过 实施类似的以办公室为基础的干预措施，并辅之以实践促进，以改善心血管护理。 我们的具体目标是1)开发和部署在线继续医学教育计划，以支持门诊 对不良酒精者实施行为干预和药物辅助治疗 使用并确定可能从进一步转诊中受益的患者。2)进行随机分步骤练习 在小型初级保健实践中进行楔形试验，以确定基于电子健康记录的检查表的采用和有效性 改进对不健康饮酒人群的筛查和治疗。3)评估小企业的能力 我区实践性参与实践教育项目并贯彻和维持标准 适用于EHR文件的筛查和治疗方案，并确定符合以下条件的因素 使用定量和定性分析方法促进或阻碍改进和可持续性。一个 我们计划的重要成果将是强有力的、可持续的教育和质量改进 可在整个地区部署和传播的基础设施，以支持减少不健康 酗酒。

ABSTRACT Unhealthy alcohol use is a leading cause of preventable mortality and a risk factor for an array of social and health problems with an estimated annual economic impact of $249 billion. Despite the significant public health impact of unhealthy alcohol use, rates of screening across the country remain low. In Illinois and Wisconsin, two states with the highest levels of unhealthy alcohol use in the Midwest, less than 17% of patients receive screening in a primary care setting and only 5% of patients with reported heavy alcohol use receive treatment. Effective screening and treatment in small practices is limited by lack of clinician education around screening and management, low rates of prescribing medications for alcohol use disorder, poor availability of referral programs, and difficulty integrating interventions into existing clinical workflows. Checklist-based screening tools present a simple, easy to understand strategy and have been successfully applied within the healthcare setting. In this project, we aim to test the feasibility and effectiveness of office-based screening supported by behavioral and medication-based interventions in primary care practices, through an integrated platform of education, practice facilitation, and embedded EHR technology. The project brings together a complementary team of experts from academic institutions, a quality improvement organization, practice-based research networks and independent research organizations, a majority of whom have previously worked together to implement similar office-based interventions supported by practice facilitation to improve cardiovascular care. Our specific aims are to 1) Develop and deploy online CME education programs to support the in-clinic implementation of behavioral intervention and medication assisted treatment for people with unhealthy alcohol use and identify patients who may benefit from further referral. 2) Conduct a practice randomized stepped wedge trial in small primary care practices to determine the adoption and efficacy of an EHR-based checklist to improve screening and treatment for people with unhealthy alcohol use. 3) Evaluate the ability of small practices in our region to participate in practice education programs and implement and sustain standard screening and treatment protocols adapted for documentation in the EHR and identify the factors that facilitated or hindered improvement and sustainability using quantitative and qualitative analysis methods. An important outcome of our program will be a robust, sustainable education and quality improvement infrastructure that can be deployed and disseminated throughout our region to support reduction of unhealthy alcohol use.