ReDIAL: A Telephone Brief Intervention for Injured Emergency Department Patients

描述(申请人提供)：本研究计划的长期目标是减少在医院急诊科(ED)就诊的受伤患者中的不良驾驶、危险饮酒和与酒精相关的伤害。目前拟议的项目REDIAL将在概念上复制、加强和寻求理解DIAL(最近完成的疾控中心资助的RCT)的结果，该结果确立了电话传递的短暂干预(TBI)在减少危险饮酒的ED受伤患者中减少受损驾驶和降低与酒精相关的伤害频率方面的可接受性和有效性。REDIAL的主要目的是：检查更密集的电话脑损伤(增加脑外伤的助推器治疗)对1)高风险饮酒和酒精相关伤害的影响；2)受损驾驶和其他与驾驶相关的负面后果；3)评估筛查加脑损伤的成本效益；4)确定改变的机制和治疗的有效成分，解释脑损伤对近端和远期结局的影响；以及5)确定和评估患者的倾向对脑外伤与高风险驾驶和酒精损伤的变化之间的关系的影响。这项研究将招募筛查出危险饮酒阳性(即超过NIAAA质量/频率指南)的受伤ED患者。符合资格的患者将在急诊科获得同意，并将在1周内获得初次联系电话的预约。在最初的电话通话中，研究参与者将收到评估，然后被随机分成两种情况之一：1)脑外伤或2)接受家庭安全教育计划的对照对照组。这两种方案都将通过三次电话会议提供：最初的电话(随机化后立即进行)和在随机化后的2周和6周进行的两次强化电话。在随机化后的4个月、8个月和12个月，对参与者进行危险饮酒、酒精相关伤害、驾驶障碍和其他与驾驶相关的负面后果的水平评估。REDIAL解决了NIAAA 2008-2013战略计划中的一个重点领域，即确定战略，以加强筛查、简要干预和适当转诊至其他服务和PA-07-066研究目标：确定和评估行为治疗行动的潜在机制，并制定有效战略，旨在帮助系统确定和实施适当的经验支持的干预措施。美国急诊科每年因损伤就诊3000万人次，ED患者中危险饮酒的流行率在20%-30%之间，REDIAL在实现其目标方面的成功使TBI有可能成为常规ED临床护理的公认组成部分，并防止未来发生伤害。

DESCRIPTION (provided by applicant): The long-term goal of the present program of research is to reduce impaired driving, risky drinking and alcohol- related injuries among injured patients who present in a hospital emergency department (ED). The current proposed project, ReDIAL, will conceptually replicate, strengthen and seek to understand the findings of DIAL (recently completed CDC-funded RCT), which established the acceptability and effectiveness of telephone- delivered brief intervention (TBI) in reducing impaired driving and decreasing the frequency of alcohol-related injuries among injured ED patients with risky alcohol use. ReDIAL primary aims are to: examine the effects of a more intensive telephone BI (added booster session of TBI) on 1) risky alcohol use and alcohol related injuries; 2) impaired driving and other driving related negative consequences; 3) estimate the cost effectiveness of screening plus TBI 4) identify mechanisms of change and the active ingredients of treatment that explain the effect of TBI on proximal and distal outcomes; and 5) identify and assess the effect that patient predispositions have on the relationship between TBI and changes in risky driving and alcohol injuries. This study will recruit injured ED patients who screen positive for risky alcohol use (i.e. exceed NIAAA quanity/frequency guidelines). Eligible patients will be consented in the ED and will receive an appointment for an initial contact call within 1 week. At the initial telephone call the research participant will receive an assessment and then will be randomized into one of two conditions: 1) TBI or 2) a comparison control group with a home safety educational program. Both will be provided over three telephone sessions: the initial call (immediately following randomization) and two booster calls at 2 weeks and 6 weeks after randomization. Participants are assessed for levels of risky alcohol use, alcohol-related injuries, impaired driving, and other driving related negative consequences at 4, 8, and 12 months post-randomization. ReDIAL addresses a focus area in the NIAAA 2008-2013 strategic plan in identifying strategies to enhance screening, brief interventions, and appropriate referrals to additional services and PA-07-066 research objectives: identification and evaluation of mechanisms underlying the actions of behavioral therapies and the development of effective strategies aimed at assisting systems to identify and implement appropriate empirically-supported interventions. With 30 million yearly US ED visits for injuries and the prevalence of risky alcohol use between 20-30% in ED patients, ReDIAL's success in achieving its aims has the potential for TBI to become an accepted part of routine ED clinical care and prevent future injury occurrence.