AAME: Implementing SBIRT in Patient-Centered Medical Homes

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Abstract In response to NOT-AA-20-011, this administrative supplement will enhance the Screening, Brief Intervention and Referral to Treatment (SBIRT) support solution proposed in the parent grant (1R43AA028453-01) to help combat the dangerous combination of risky alcohol use behaviors and COVID-19, and to address the new challenges to SBIRT implementation in primary care during the COVID-19 era. The implementation of SBIRT 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. 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 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 EHRs and also help satisfy the documentation requirements for Medicare/Medicaid reimbursements and for PCMH Recognition. In this supplement, we will enhance AAME with self-report measures to specifically address patients’ risky behaviors for alcohol use and for COVID infection and transmission. We will also account for changes in the practice’s clinical workflows and SBIRT protocol due to COVID-related policy restrictions. The Phase I aims of the parent grant are: 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. In this supplement, we will extend the interviews in Aim 1 to help understand the relationship between the COVID-19 pandemic and drinking behavior/AUD, and the impacts of COVID-19 on SBIRT protocol and clinic workflows. We will also implement a suite of COVID-19 specific screening measures in Aim 2 to give primary care practices the necessary tools to assess COVID-19 risks and impacts, all within an integrated SBIRT support environment.