Addressing Homelessness and Substance Use in Emergency Department Patients

 描述(由申请者提供)：这项以患者为导向的研究职业发展奖(K23)将支持凯利·多兰博士在药物使用和无家可归这两个相互关联的问题上的培训和研究。每年有150多万美国人无家可归。酗酒和吸毒都是无家可归的危险因素，而吸毒和无家可归的问题会相互加剧。使用药物和无家可归都与不良的健康结果有关，包括发病率和死亡率的增加，以及经常使用昂贵的保健服务。美国的无家可归政策越来越注重预防，但针对高危人群的理想预防干预方法研究较少。此外，预防干预措施只惠及一小部分自我选择的人群。作为卫生保健系统的安全网，急诊科为大量不健康的酗酒或吸毒患者提供服务，这些患者面临无家可归的风险，可能无法在其他地方获得服务。这项拟议研究的总体目标是确定对饮酒或吸毒不健康的ED患者进行风险筛查和防止无家可归的最佳方法。具体的研究目标是：1)开发一种简单的筛查工具，用于识别ED患者 这项研究的目的是：2)通过深入的定性访谈，了解预防饮酒或吸毒不良的勃起功能障碍患者无家可归的干预措施的发展情况；3)开展一项基于勃起功能障碍的干预措施的可行性研究，以防止酗酒或吸毒不良的患者无家可归。这项研究的结果将为未来的R系列应用提供信息，以在有无家可归风险的不健康的酒精或药物使用的ED患者中进行无家可归预防和物质使用干预的试验。多兰博士将接受一个跨学科专家团队的指导，这些专家涉及卫生服务研究、定性和混合方法、预防和干预科学、药物滥用和无家可归问题。拟议的研究和培训将在贝尔维尤医院中心和纽约大学进行，贝尔维尤医院中心是美国历史最悠久的公共安全网医院，纽约大学医学院和其他多所专业学校拥有无与伦比的合作工作和学习机会。多兰博士的这一职业发展奖的培训目标是发展和提高以下方面的技能：1)调查设计和心理测量理论，2)先进的卫生服务研究方法，3)先进的定性和混合方法，4)干预和预防科学，以及5)药物滥用、成瘾和无家可归。拟议的研究和培训计划将为多兰博士的职业生涯奠定坚实的基础，他将成为一名独立资助的临床调查员，致力于研究药物使用和无家可归这两个相互关联的问题。

 DESCRIPTION (provided by applicant): This mentored patient-oriented research career development award (K23) will support Dr. Kelly Doran's training and research on the interrelated problems of substance use and homelessness. More than 1.5 million Americans experience homelessness each year. Alcohol and drug use are both risk factors for homelessness, and the problems of substance use and homelessness can each exacerbate the other. Both substance use and homelessness are associated with poor health outcomes, including increased morbidity and mortality, and frequent use of expensive health care services. Homelessness policy in the U.S. is increasingly focused on prevention, yet ideal methods for targeting prevention interventions to at-risk people have been sparsely researched. Furthermore, prevention interventions only reach a small and self-selected subset of people. As the safety net of the health care system, emergency departments (EDs) serve large numbers of patients with unhealthy alcohol or drug use who are at risk for homelessness and may not access services elsewhere. The overall goal of the proposed research is to identify optimal approaches to risk screening and prevention of homelessness in ED patients with unhealthy alcohol or drug use. The specific research aims are: 1) to develop a brief screening tool that will identify ED patients with unhealthy alcohol or drug use who are at significant risk for future homelessness, 2) to use in-depth, qualitative interviews to inform the development of an intervention to prevent homelessness among ED patients with unhealthy alcohol or drug use, and 3) to conduct a feasibility study of an ED-based intervention to prevent homelessness among patients with unhealthy alcohol or drug use. The results of this research will inform a future R-series application to conduct a trial of homelessness prevention and substance use interventions among unhealthy alcohol or drug using ED patients at risk for homelessness. Dr. Doran will be mentored by a transdisciplinary team of experts in health services research, qualitative and mixed methods, prevention and intervention science, substance abuse, and homelessness. The proposed research and training will be conducted at Bellevue Hospital Center, the oldest public safety net hospital in the United States, and at New York University, whose School of Medicine and multiple other professional schools boast unparalleled opportunities for collaborative work and learning. Dr. Doran's training goals for this career development award are to develop and enhance skills in: 1) survey design and psychometric theory, 2) advanced health services research methods, 3) advanced qualitative and mixed methods, 4) intervention and prevention science, and 5) substance abuse, addiction, and homelessness. The proposed research and training plans will provide a strong foundation for Dr. Doran's career as an independently funded clinical investigator dedicated to the interconnected problems of substance use and homelessness.