Micro-targeted Computerized Alcohol Misuse Intervention System for Health Care

描述（由申请人提供）：酒精滥用继续对公众健康构成重大负担。几十年来一直建议在初级保健机构中对酒精滥用进行筛查和短暂干预，并且在初级保健中支持这一建议的证据基础是强有力的。然而，许多初级保健提供者不干预酒精滥用，而那些干预的人往往没有系统地或按照最佳证据标准进行干预。酒精滥用筛查和简短干预的计算机化有望减轻许多阻碍其纳入常规护理的障碍，并为优化简短干预的有效性提供新的机会。这个第二阶段的STTR项目是在Research Circle Associates在第一阶段成功的概念验证工作的基础上进行的，这导致了一个多功能软件平台（interonaire (c)）的开发，以支持计算机化的酒精滥用筛查和使用基于证据的策略（包括动机性访谈和规范性反馈）的简短干预。我们的计算机化酒精滥用干预包括一个规范反馈组件，其独特之处在于其基于参与者人口统计学特征（种族/民族、性别和年龄）的酒精使用反馈的微观目标，从国家药物使用和健康调查中提取人口规范数据。这代表了流行病学数据为临床服务提供信息的一种新用途。第二阶段的项目旨在回答一些重要的研究问题，并为产品的成功商业化做好准备。具体来说，在第二阶段，我们打算对（Interventionaire(c)）平台进行一些改进，以提高其可用性，并通过定制反馈简化复杂内容的创建。我们还将升级软件，使其与我们的临床合作伙伴网站使用的主要电子健康记录系统兼容。这将增加产品的覆盖范围，并确保为部署到现代医疗保健市场（一个充满活力和快速发展的行业）做好最大准备。我们还将在我们的临床合作伙伴现场进行一项研究，使用定性关键信息提供者、焦点小组和调查方法来调查采用计算机化酒精筛查和简短干预系统的障碍。一个关键的问题是电脑酒精滥用干预在改变饮酒行为方面是否有效。为了回答这个问题，我们将进行一项交叉随机对照试验，与“注意力控制”（安慰剂）一般健康促进信息相比，通过微目标规范反馈和激励信息来检验计算机化酒精滥用干预的短期影响。该试验将有助于确定干预措施的短期疗效，并为更大规模的试验和在医疗保健环境中采用该产品奠定基础。最后，我们将在有关干预效应大小、目标人群和产品渗透率的各种假设下，对干预的经济和健康影响进行预测分析。满足这些第二阶段目标将使RCA为商业化部署该产品做好充分准备，这将利用市场的力量来改善临床服务提供并促进公共卫生。

DESCRIPTION (provided by applicant): Alcohol misuse continues to pose a major burden for public health. Screening and brief intervention for alcohol misuse in primary care settings has been recommended for decades, and the evidence base supporting it in primary care is robust. However, many primary care providers do not intervene in alcohol misuse, and those that do often fail to do so systematically or in accordance with best-evidence standards. Computerization of screening and brief intervention for alcohol misuse holds the promise of alleviating many of the barriers that have prevented its adoption into routine care, and also offers new opportunities for optimizing the effectiveness of brief interventions. This Phase 2 STTR project follows up on Research Circle Associates' successful proof- of-concept work done under Phase 1, which led to the development of a versatile software platform (Interventionaire(c)) to support computerized alcohol misuse screening and brief intervention using evidence- based strategies including motivational interviewing and normative feedback. Our computerized alcohol misuse intervention includes a normative feedback component that is unique in its micro-targeting of alcohol use feedback based on participant demographic characteristics (race/ethnicity, gender, and age), drawing population normative data from the National Surveys on Drug Use and Health. This represents a novel use of epidemiological data to inform clinical services. The Phase 2 project is designed to answer a number of important research questions and prepare the product for successful commercialization. Specifically, during Phase 2 we intend to implement several refinements into the (Interventionaire(c)) platform that will increase its usability and streamline the creation of complex content with tailored feedback. We will also upgrade the software to make it compatible with a major electronic health record system used by our clinical partner site. This will increase the reach of the product and ensure maximum readiness for deployment into the modern healthcare marketplace, a dynamic and rapidly evolving industry. We will also conduct a study at our clinical partner site using qualitative key informant, focus group, and survey methodologies to investigate barriers to adopting computerized alcohol screening and brief intervention systems. A critical question is whether the computerized alcohol misuse intervention is effective in changing drinking behavior. To answer this question, we will conduct a cross-over randomized controlled trial examining the short-term impact of the computerized alcohol misuse intervention with micro-targeted normative feedback and motivational messaging compared to an "attention-control" (placebo) generic health promotion message. This trial will help to establish the short- term efficacy of the intervention and set the stage for larger trials and adoption of the product i healthcare settings. Finally, we will conduct a projection analysis of the economic and health impacts of the intervention under a variety of assumptions regarding intervention effect size, target population, and product penetration. Satisfying these Phase 2 objectives will leave RCA well-poised to deploy the product commercially, which will leverage the power of the market to improve clinical service delivery and promote public health.