AAME: Implementing SBIRT in Patient-Centered Medical Homes

AAME：在以患者为中心的医疗之家实施 SBIRT

• 批准号: 10273122
• 负责人: Niina M. Haas
• 金额: $ 9.99万
• 依托单位: BRIGHTOUTCOME INC.
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10273122
• 关键词: Address; Administrative Supplement; Adoption; Alcohol abuse; Alcohol consumption; Behavior; Behavioral; COVID-19; COVID-19 pandemic; Caring; Clinic; Dangerousness; Documentation; Elements; Environment; Evaluation Studies; Fast Healthcare Interoperability Resources; Feedback; Health Personnel; Health Technology; Home; Individual; Infection; Interview; Measures; Medical center; Medicare/Medicaid; Modeling; Patient Monitoring; Patient Self-Report; Patients; Phase; Pilot Projects; Policies; Primary Health Care; Process; Provider; Research Personnel; Resources; Risk; Risk Behaviors; Services; Substance abuse problem; System; Treatment Protocols; base; behavioral health; care coordination; clinical decision-making; clinical practice; combat; coronavirus disease; cost; design; digital health; drinking behavior; experience; implementation facilitation; improved; medical specialties; parent grant; patient oriented; patient screening; population health; primary care setting; prototype; reduced alcohol use; response; screening; screening, brief intervention, referral, and treatment; tool; transmission process; usability; user centered design

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.

摘要 作为对NOT-AA-20-011的回应，本行政补充文件将加强筛选、短暂干预 和转诊治疗（SBIRT）支持解决方案中提出的父母补助金（1 R43 AA 028453 -01），以帮助 对抗危险饮酒行为和COVID-19的危险结合，并解决新的问题 COVID-19时代初级保健中实施SBIRT面临的挑战。 SBIRT的实施已证明在减少酒精使用方面是有效的。然而，它的真实的障碍 在初级保健环境中实施。以病人为中心的医疗之家（PCMH）是一个初级保健 该模式旨在帮助改善人口健康，降低成本，并为患者提供更好的护理体验。 行为服务现在是PCMH的一个核心方面，药物滥用护理是PCMH的一个关键要素 行为服务初级保健行为健康（PCBH）模式是整合了 将行为护理纳入初级护理PCMH，特别是PCBH，有利于SBIRT的实施。 我们建议发展以诊所为基础的酒精滥用管理环境系统， 在PCMH中实施SBIRT的所有阶段。AAME将被设计为帮助实践跟踪和 监测患者进展，协助共享临床决策过程，并与内部护理协调 以及整个SBIRT过程中的外部专业资源。AAME将与EHR集成， 满足Medicare/Medicaid报销和PCMH认可的文件要求。在 在本补充文件中，我们将通过自我报告措施加强AAME，以专门解决患者的风险 饮酒和COVID感染和传播的行为。我们还将考虑到 实践的临床工作流程和SBIRT协议，由于COVID相关的政策限制。 母基金的第一阶段目标是：1）收集利益相关者对预期系统功能的反馈， 来自AUD患者和SBIRT提供者的感知有用性和采用促进因素/障碍， 2）使用以用户为中心的设计和最新的 数字医疗技术，包括FHIR/SMART EMR集成的原型设计;以及3）进行两轮 对患者和供应商进行评估研究。第一轮将是个人面试， 设计原型以获得早期反馈。第二轮将是在真实的PCMH环境中进行的为期一周的试点研究， 评估系统的可用性、有用性和可接受性。在本增刊中，我们将在 目的1帮助了解COVID-19大流行与饮酒行为/AUD之间的关系，以及 COVID-19对SBIRT方案和诊所工作流程的影响。我们还将实施一套新冠肺炎 目标2中的具体筛查措施，为基层医疗实践提供评估COVID-19的必要工具 风险和影响，所有这些都在集成的SBIRT支持环境中。