IAMSBIRT: Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers

项目总结 美国外科医生学会要求对酒精滥用进行普遍筛查，并提交一份简短的 对筛查呈阳性的患者进行干预，作为认证为一级创伤中心的要求。尽管 这一要求已经强制执行了十多年，其执行一直具有挑战性，特别是对于 儿科创伤中心。我们目前资助的研究，IAMSBIRT，测试了一个全面的 年加强酒精和其他药物(AOD)SBIRT实施的实施战略 通过III型混合有效性-实施试验建立儿科创伤中心。这一目标已经实现 通过：主要目标：评估SSL实施战略在提高数据保真度方面的有效性 儿童创伤中心的SBIRT分娩，相对于通常的实施；次要目标1：评估 为组织变革做好准备是否会影响SSL实施战略对 实施效果(即SBIRT交付的保真度)；次要目标2：评价安全套接线的效果 改善患者与适当护理的联系的实施战略(即，继续与AOD讨论 初级保健提供者和/或AOD治疗)从儿科创伤中心出院；以及 探索性目标：检查关于处方止痛药使用的咨询整合到 对AOD筛查阳性的受伤青少年患者进行SBIRT分娩。利用阶梯形楔形 设计，一个由10个儿科创伤中心组成的国家队列获得了SSL实施战略。六点整 时间点，每个站点提供来自30个电子健康记录(EHR)样本的数据； 青少年报告干预、分娩和与护理的联系的忠诚度。每个儿科的临床工作人员 创伤中心报告组织在三个不同时间点的实施准备情况。这个 所要求的行政补充将扩大我们的EHR审查范围，以涵盖所有被录取的青少年 在出院后30天检查提供者的临床记录的楔形(包括已经发生的) 创伤中心就诊后与护理(AOD随访讨论/AOD治疗)相关联的证据。这 鉴于研究方案因以下原因而发生变化，因此有必要进行更改以有效地检查次级目标2 新冠肺炎大流行。这项研究的结果将表明，高度可扩展的实施战略将 提高儿科创伤中心SBIRT分娩的保真度(即一致性和质量)。

PROJECT SUMMARY The American College of Surgeons mandate universal screening for alcohol misuse and delivery of a brief intervention for those screening positive as a requirement for certification as a level one trauma center. Though this requirement has been mandated for over a decade, its implementation has been challenging, especially for pediatric trauma centers. Our currently funded study, IAMSBIRT, tests the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug (AOD) use in pediatric trauma centers through a Type III hybrid effectiveness-implementation trial. This goal is accomplished through: Primary Aim: Evaluate the effectiveness of the SSL implementation strategy in increasing fidelity of SBIRT delivery at pediatric trauma centers, relative to usual implementation; Secondary Aim 1: Evaluate whether readiness for organizational change mediates the influence of the SSL implementation strategy on implementation effectiveness (i.e., fidelity of SBIRT delivery); Secondary Aim 2: Evaluate the effect of the SSL implementation strategy on improving patient linkage to appropriate care (i.e., continued AOD discussion with primary care provider and/or AOD treatment) following discharge from pediatric trauma centers; and Exploratory Aim: Examine the integration of counseling regarding the use of prescription pain relievers into SBIRT delivery with injured adolescent patients who screen positive for AOD use. Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers receive the SSL implementation strategy. At six distinct time points, each site provides data from a sample of thirty electronic health records (EHRs); a subset of adolescents report on fidelity of intervention delivery and linkage to care. Clinical staff from each pediatric trauma center report on organizational readiness for implementation at three distinct time points. The administrative supplement requested will expand our EHR review to be of all admitted adolescents across all wedges (including those already occurred) to examine providers’ clinical notes 30 days post discharge for evidence of linkage to care (AOD follow up discussions/ AOD treatment) after the trauma center visit. This change is necessary to effectively examine Secondary Aim 2 given changes in the research protocol due to the COVID-19 pandemic. Results of this study will demonstrate that a highly scalable implementation strategy will improve the fidelity (i.e., the consistency and quality) of SBIRT delivery in pediatric trauma centers.