Development and Testing of an Integrated Care Coordination Intervention for Alcohol Use Disorder Recovery after Liver Transplantation

项目总结 酒精使用障碍和酒精相关性肝病需要肝移植的比率继续上升 迅速崛起。肝移植后再次饮酒与肝移植成功率的增加有关 失败和死亡率，但没有基于证据的综合干预措施来解决酒精使用障碍 肝移植受者。一位肝脏移植外科医生提交的这份K23奖项申请的目标是 解决肝移植受者并发酒精使用障碍的知识和护理方面的严重差距 通过开发和试点测试综合肝移植和酒精回收计划(ILTARP)，包括 综合社区卫生工作者支持移植后酒精复发的预防、外展和 护理协调。为了解决这一知识鸿沟，我提出了三个研究目标。目标1是共同开发 ILTARP通过证据收集和迭代过程与利益攸关方和专家的意见进行干预 利益相关者小组。AIM 2将对新开发的ILTARP干预进行试点可行性研究 在肝移植临床环境中测试ILTARP的可行性、可接受性和潜在有效性 通过随机对照试点试验(n=40)。目标3将评估ILTARP的障碍和促进者 通过综合混合方法进行干预，为未来R01的干预做好准备 申请全动力多站点混合动力1型有效性--实施试验。 我的长期目标是成为一名独立资助的研究人员，开发、测试和实施 实体器官移植的干预措施结合了对复杂的共生健康状况的护理。这个 研究目的直接告诉我的三个培训目标：目标1获得酒精使用方面的高级知识 障碍治疗和成瘾研究；目标2获得干预发展和成瘾的技能 多组分干预措施的随机试验；以及目标3：发展应用实施的专门知识 通过使用混合方法，研究框架和评估执行成果。培训 计划包括指导性阅读、辅导研究项目、每月研讨会和精选课程。 计划研究手稿，并经常召开导师会议以审查进展情况。这项研究项目， 研究环境和卓越的多学科指导团队(Bartels博士、Kelly博士、Aschbrenner博士) 顾问(卡梅隆博士、韦克曼博士、程博士)非常适合我的职业发展。 总体而言，这个职业发展奖将为我提供获得必要的 研究技能，推动我的职业目标，成为干预开发和研究领域的领先专家 综合护理复杂共生健康的实体器官移植实施研究 条件。这项形成性的工作有可能导致全国肝移植中心的范式转变。 通过广泛传播ILTARP来改善获得机会、公平和长期成果 越来越多的患者患有酒精使用障碍和酒精相关的肝病。

PROJECT SUMMARY Rates of alcohol use disorder and alcohol associated liver disease requiring liver transplantation continue to rapidly rise. Return to alcohol use after liver transplant is associated with increased rates of liver transplant failure and mortality, but there is no evidence-based integrated intervention to address alcohol use disorder in liver transplant recipients. The goal of this K23 award application submitted by a liver transplant surgeon is to address a critical gap in knowledge and care for liver transplant recipients with concurrent alcohol use disorder by developing and pilot testing an integrated liver transplant and alcohol recovery program (ILTARP) consisting of an integrated community health worker supporting post-transplant alcohol relapse prevention, outreach, and care coordination. To address this knowledge gap, I propose three research aims. Aim 1 is to co-develop the ILTARP intervention with stakeholder and expert input though an iterative process of evidence gathering and stakeholder panels. Aim 2 will conduct a pilot feasibility study of the newly developed ILTARP intervention testing feasibility, acceptability, and potential effectiveness of ILTARP in the liver transplant clinical setting through a randomized control pilot trial (n=40). Aim 3 will assess barriers and facilitators of the ILTARP intervention through an integrated mixed methods approach to prepare the intervention for a future R01 application for a fully powered multisite Hybrid Type 1 effectiveness-implementation trial. My long-term goal is to be an independently funded researcher developing, testing and implementing interventions in solid organ transplantation integrating care of complex co-occurring health conditions. The research aims directly inform my three training goals: Goal 1 to gain advanced knowledge in alcohol use disorder treatment and addictions research; Goal 2 to acquire skills in intervention development and randomized trials of multi-component interventions; and Goal 3 to develop expertise applying implementation research frameworks and evaluating implementation outcomes through the use of mixed methods. The training plan includes guided reading, mentored research projects, monthly seminars, and selected coursework, planned research manuscripts, and frequent mentor meetings to review progress. The research project, the research environment, and the exceptional multidisciplinary mentorship team (Drs. Bartels, Kelly, Aschbrenner) and consultants (Drs. Cameron, Wakeman, Cheng) are ideally suited to my career development. Overall, this career development award will provide the opportunity for me to acquire the necessary research skills to advance my career goal to become a leading expert in intervention development and implementation research in solid organ transplantation integrating care of complex co-occurring health conditions. This formative work has the potential to result in a paradigm shift in liver transplant centers across the nation by broadly disseminating ILTARP to improve access, equity, and long-term outcomes for the growing number of patients suffering from alcohol use disorder and alcohol associated liver disease.