Three Strategies for Implementing Motivational Interviewing on Medical Inpatient

描述（由申请人提供）：综合医疗医院为滥用或依赖药物的患者提供不成比例的护理。这一群体是治疗费用最高的群体之一，其医疗和药物使用结果最差。住院治疗提供了一个独特的机会，以确定和激励患者解决他们的物质使用问题，因为患者：1）可访问; 2）有时间进行干预; 3）经常因与物质使用有关的并发症而入院，这使得住院治疗成为一个“可教的时刻”。增加药物滥用治疗动机的简短干预措施非常适合住院医疗环境，但实施此类干预措施的最佳方法尚未得到充分研究。我们建议使用定量和定性的方法来研究三种不同的实施策略的有效性整合动机访谈（MI）到实践中的医生助理（PA）在耶鲁大学纽黑文医院的一般医疗住院服务。具体地说，我们将30名私人助理随机分为以下三种情况：（1）继续医学教育讲习班，提供背景知识，并向私人助理“展示”如何进行MI（2）“看一做一”的实习模式，包括车间培训和现场指导床旁实践（DO ONE）;以及（3）在车间中了解MI之后从CL订购MI（订购一个）。在各自的MI培训后，将评估每名PA是否向40名研究合格住院患者提供MI，这些患者在进入我们的普通医疗单位后由研究团队招募。将从质量上探讨执行问题。我们的主要目的是评估：1）由PA的MI摄取; 2）MI的完整性时，PA使用它的医疗单位;和3）三种不同的实施策略的相对成本和成本效益。

DESCRIPTION (provided by applicant): General medical hospitals provide care for a disproportionate share of patients who abuse or are dependent upon substances. This group is among the most costly to treat and has the poorest medical and substance use outcomes. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance use problems in that patients are: 1) accessible; 2) have time for an intervention; and 3) are often admitted for complications related to substance use that renders hospitalization a "teachable moment". Brief interventions that increase motivation for substance abuse treatment are well suited for an inpatient medical setting but optimal methods for the implementation of such interventions are not well researched. We propose to use quantitative and qualitative methods to examine the effectiveness of three different implementation strategies for integrating motivational interviewing (MI) into the practice of physician assistants (PAs) working within Yale-New Haven Hospital's general medical hospitalist service. Specifically, we will randomize 30 PAs to one of three conditions: (1) a continuing medical education workshop that provides background and "shows" PAs how to conduct MI (the control condition, called SEE ONE); (2) a "see one, do one" apprenticeship model involving workshop training plus live supervision of bedside practice (DO ONE); and (3) ordering MI from CL after learning about it in a workshop (ORDER ONE). Following the respective MI trainings, each PA will be assessed for the provision of MI to 40 study-eligible inpatients, recruited by the research team after admission to our general medical units. Implementation issues will be explored qualitatively. Our primary aims are to assess: 1) the uptake of MI by PAs; 2) the integrity of MI when PAs use it on the medical units; and 3) the relative costs and cost-effectiveness of the three different implementation strategies.