Integrating Alcohol Screening, Brief Intervention, and Referral to Treatment into Presurgical Care

 描述(由申请人提供)：这项K23提案的总体目标是支持Anne Fernandez博士的早期职业发展，她是一位在成瘾和健康心理学方面具有专门知识的临床心理学家。这一奖项将促进她的研究计划-评估和实施筛查、简短干预和转诊治疗(SBIRT)在新的医疗环境中的酒精使用障碍。她的职业目标是通过精心安排的酒精使用干预措施，改善患者健康，改善医院结果，并降低医疗成本。在这个职业发展奖(CDA)中，她将通过在四个培训领域发展专业知识来促进这些职业目标：(1)多学科卫生服务研究，(2)SBIRT实施实践，(3)定性数据收集和分析，以及(4)医学研究中的定量方法。她将通过专家指导、正式的课程作业和实践研究来获得这种培训。CDA的研究部分是一项随机对照试验，将在择期手术前试点测试SBIRT的高风险酒精使用。这项CDA建立在现有研究的基础上，该研究表明，适度饮酒(每天2杯)会增加术后发病率的风险，而大量饮酒(每天4杯)会增加术后死亡的风险。这些风险因素增加了卫生保健服务的利用率，给患者、提供者和卫生保健系统带来了不必要的负担。到目前为止，还没有随机对照试验评估SBIRT是否可以减少择期手术前的酒精使用并改善术后健康结果。这款K23将在解决这一研究差距方面迈出第一步。这三项研究的目的是：(1)评估医疗系统以指导术前酒精SBIRT的实施，(2)在术前诊所进行SBIRT的开放试验，以及(3)在择期手术前进行酒精SBIR的随机试点试验。这些研究目标纳入了几个新的组成部分，包括混合方法的医疗评估以及对疗效和实施结果的同时评估。这些步骤将确保该协议满足更大的医疗保健系统的需求。研究的成功完成将带来有关SBIRT在手术前用于危险饮酒的可行性、可接受性和有效性的新信息。这一研究和培训计划将使应聘者能够开始进行以患者为导向的研究，最终将减少有问题的酒精使用，改善患者健康，改善医院结果，并降低术后护理成本。

 DESCRIPTION (provided by applicant): The overall objective of this K23 proposal is to support the early career development of Dr. Anne Fernandez, a clinical psychologist with specialized expertise in addiction and health psychology. This award will facilitate her program of research - evaluating and implementing screening, brief interventions, and referral to treatment (SBIRT) for alcohol use disorders in novel medical settings. Her career goal is to improve patient health, enhance hospital outcomes, and reduce healthcare costs through carefully timed alcohol-use interventions. In this career development award (CDA), she will facilitate these career goals by developing expertise in four training areas: (1) multi-disciplinar health services research, (2) SBIRT implementation practices, (3) qualitative data collection and analysis, and (4) quantitative methods in medical research. She will acquire this training through expert mentorship, formal coursework, and hands-on research. The research portion of this CDA is a randomized controlled trial that will pilot test SBIRT for risky alcohol use prior to elective surgery. This CDA builds on existing research indicating that moderate alcohol use (> 2 drinks/day) increases the risk of postoperative morbidity, while heavy alcohol use (> 4 drinks/day) increases the risk of postoperative mortality. These risk factors increase utilization f health care services, placing undue burden on patients, providers, and the healthcare system. To date, no randomized controlled trial has ever evaluated whether SBIRT can reduce alcohol use prior to elective surgery and improve postoperative health outcomes. This K23 will take the first steps in addressing this research gap. The three research aims are to: (1) assess the healthcare system to guide implementation of presurgical alcohol SBIRT, (2) to conduct an open trial of SBIRT in a presurgical clinic, and (3) to conduct a randomized pilot trial of alcohol SBIR prior to elective surgery. These research aims incorporate several novel components, including a mixed-method healthcare assessment and simultaneous evaluation of both efficacy and implementation outcomes. These steps will ensure the protocol addresses the needs of the larger healthcare system. Successful study completion will result in new information regarding the feasibility, acceptability, and efficacy of SBIRT for risky drinking prior to surgery. This program of research and training will allow the candidate to initiate a career conducting patient-oriented research that will ultimately reduce problematic alcohol use, improve patient health, bolster hospital outcomes, and reduce the cost of postoperative care.