Alcohol Use Disorder Treatment Simulation: Modeling treatment impacts on alcohol-related disparities

项目摘要/摘要 过度饮酒会导致巨大的经济和社会成本，是可预防的主要原因 美国的死亡事件。只有一小部分酒精使用障碍(AUD)患者获得适当的 服务，人们在获得酒精健康服务方面存在很大差距，原因是 种族/民族、性别、社会经济地位和都市性。拟议的研究将回应紧迫的问题 关于如何减少准入差距的问题，使用模拟建模来检查 普遍增加获得循证实践(EBP)的机会，如筛查、短暂干预和 转诊治疗(SBIRT)或药物辅助治疗可以减少差异，或者更多 需要有针对性地努力改善获得机会，以便接触到高优先人口亚群。模拟法 模型非常适合于识别在复杂的环境中实施的干预的意外后果 系统以及实施数年后可能出现的结果。通过预测干预效果 随着时间的推移，跨人群分组的模拟建模可以帮助识别酒精类型并确定其优先顺序 减少澳元差距的卫生服务干预措施。尽管模拟方法被用来 解决阿片类药物危机，到目前为止，还没有公布的模拟模型全面描述 酒精健康服务的连续性与澳元的差距。拟议的研究通过以下方式填补了这一空白 模拟SBIRT在整个护理过程中更多地获得酒精健康服务的影响， 到特殊护理(包括AUD药物)和非正式治疗(包括12步小组，如 匿名酗酒者)，与健康差距有关。首先，我们将构建和校准一个微观模拟 为轻、中、重度AUD患者提供酒精健康服务的模式 包括个人、组织、社区和政策层面的治疗障碍的模式。下一首, 我们将使用地理位置的模拟人口来代表大量的、人口统计和 加利福尼亚州和得克萨斯州地理位置不同的州，对澳州的严重程度和 随着时间的推移，关键人口亚组的恢复。最后，从医疗保健可获得性和 利用，我们将预测在几种增强条件下AUD治疗差异的变化，以确定 服务的组合和分配将最好地缩小差距，我们估计 改进了服务接入。研究的目的是评估(1)全面实施循证医学计划的效果。 传统和非传统环境以及(2)改善可获得性、可用性、可负担性和 酒精健康服务的可接受性差异，以及(3)估计酒精健康服务的成本和成本效益 这些变化。结果将提供详细信息，为各州、县和 社区改善卫生服务，包括如何以及在哪里干预成本的预测- 以有效的方式减轻澳元的负担，增加弱势群体的长期恢复。

PROJECT SUMMARY/ABSTRACT Excessive drinking results in tremendous economic and social costs and is a leading cause of preventable death in the US. Only a small minority of people with alcohol use disorder (AUD) receive appropriate services, and there are large disparities in access to alcohol health services for people based on race/ethnicity, gender, socioeconomic status, and urbanicity. The proposed study will answer pressing questions about how to reduce disparities in access, using simulation modeling to examine whether universal increases in access to evidence-based practices (EBPs) such as screening, brief intervention, and referral to treatment (SBIRT) or medication-assisted treatment can reduce disparities, or whether more targeted efforts to improve access are needed to reach high-priority population subgroups. Simulation models are well-suited for identifying unintended consequences of interventions implemented in complex systems, as well as outcomes that may occur years after implementation. By projecting intervention effects across population subgroups over time, simulation modeling can help identify and prioritize types of alcohol health services interventions to reduce AUD disparities. Although simulation methods are being used to address the opioid crisis, to date there is no published simulation model comprehensively describing the continuum of alcohol health services in relation to AUD disparities. The proposed study fills this gap by simulating effects of increased access to alcohol health services across the continuum of care from SBIRT, to specialty care (including AUD medications) and informal treatment (including 12-step groups like Alcoholics Anonymous), in relation to health disparities. First, we will build and calibrate a microsimulation model of alcohol health services for people with mild, moderate, and severe AUD, guided by a conceptual model that includes barriers to treatment at the individual, organizational, community, and policy levels. Next, we will use a geographically situated simulated population representing the large, demographically and geographically diverse states of California and Texas to make long-term projections for AUD severity and recovery for key population subgroups over time. Finally, informed by theories of healthcare access and utilization, we will project changes in AUD treatment disparities under several enhanced conditions to identify the mix and distribution of services that would best reduce disparities, and we estimate costs and benefits of improved service access. Study Aims are to assess effects of (1) universal implementation of EBPs in traditional and non-traditional settings and (2) improving accessibility, availability, affordability, and acceptability of alcohol health services on disparities, and to (3) estimate cost and cost-effectiveness of these changes. Results will provide detailed information to inform service planning by states, counties, and communities to improve health services, including projections for how and where to intervene in a cost- effective manner to reduce the burden of AUD and increase long-term recovery for vulnerable populations.