A Telehealth Intervention to Increase Screening and Treatment for Alcohol Use Disorder

摘要 Ria Health是一家全国规模的早期远程医疗和技术公司， 治疗酒精使用障碍与饮酒的客观措施相结合（每天两次 通过我们的应用程序进行呼气测醉测量），医生监督的药物，以及小组和 个人辅导-Ria治疗平台。Ria已经招募了4,500多名患者， 在45个州提供，并由主要保险公司承保。瑞亚已经积累了超过 300 K呼吸测醉器测量入组患者的酒精含量，证明酒精含量降低 1个月时使用50%，12个月时使用75%。平均治疗时间为10个月。 酒精相关性肝病的发病率和负担正在增加。没有 自动化方法，专门筛查早期酒精相关性肝病。在这 在一个项目中，我们将使用大型电子健康记录系统（斯坦福大学的Epic 健康），以确定肝功能检查结果升高的患者， 隐匿性酒精使用障碍斯坦福大学的Epic唱片公司的可行性分析表明， > 56，460例肝功能检查（AST、ALT、GGT）升高的成人患者， 为这项研究筛选。肝功能检查结果升高的患者将被一位“诚实的”医生邀请。 经纪人”进行酒精使用障碍筛查，如果存在酒精使用障碍， 通过Ria进行治疗。 我们假设酒精使用障碍和肝功能检查升高的患者 那些本来不寻求治疗的人将有动力参与治疗。我们将 在124例受试者中进行随机等待列表对照研究，以证明 Ria治疗平台将评估一套全面的成果衡量标准， 最后4周内未重度饮酒的受试者百分比定义为主要 结果。 该项目有几个创新特点。这是第一个使用大规模筛选的一个 大型电子健康记录系统，以确定潜在的酒精使用障碍病例， 肝功能检查异常，并让他们参与治疗。鉴于发病率和 酒精使用障碍的死亡率，早期识别和参与这些患者的新方法 是迫切需要的。我们还将进行第一个随机对照试验的RIA 治疗平台，为付款人提供关键验证。

Abstract Ria Health is a nationally scaling early-stage telemedicine and technology company that treats alcohol use disorder with a combination of objective measures of drinking (twice daily breathalyzer measures through our app), physician-supervised medications, and group and individual coaching - the Ria Treatment Platform. Ria has enrolled more than 4,500 patients, is available in 45 states, and is covered by major insurers. Ria has accumulated more than 300K breathalyzer measures from enrolled patients that demonstrate a reduction in alcohol use of 50% at 1 month and 75% at 12 months. Mean retention in treatment is 10 months. The incidence and burdens of alcohol-associated liver disease are growing. There are no automated methods that screen specifically for early alcohol-associated liver disease. In this project we will use a large electronic health record system (Epic at Stanford University Health) to identify patients with elevated liver function tests who are at increased risk for occult alcohol use disorder. A feasibility analysis of Epic records at Stanford identified >56,460 adult patients with elevated liver function tests (AST, ALT, GGT) who could be screened for this study. Patients with elevated liver function tests will be invited by an “honest broker” to be screened for alcohol use disorder and, if alcohol use disorder is present, to receive treatment through Ria. We hypothesize that patients with alcohol use disorder and elevated liver function tests who would otherwise not seek treatment will be motivated to engage in treatment. We will conduct a randomized wait-list controlled study in 124 subjects to demonstrate the efficacy of the Ria Treatment Platform. A comprehensive set of outcome measures will be assessed, with percent of subjects without heavy drinking in the final 4 weeks defined as the primary outcome. The project has several innovative features. It is the first to use mass screening of a large electronic health records system to identify potential cases of alcohol use disorder with abnormal liver function tests and to engage them in treatment. Given the morbidity and mortality of alcohol use disorder, new methods to identify and engage these patients earlier are urgently needed. We will also conduct the first randomized controlled trial of the Ria Treatment Platform, providing crucial validation for payers.