AAME: Implementing SBIRT in Patient-Centered Medical Homes

摘要 筛查、简短干预和转诊治疗(SBIRT)方案的实施情况表明 有效地减少酒精的使用。然而，在初级保健环境中实施该制度的真正障碍是 是存在的。以患者为中心的医疗之家(PCMH)是为帮助改善人口状况而创建的初级保健模式 健康，更低的成本，并为患者提供更好的护理体验。行为服务现在是 药物滥用护理是PCMH行为服务的关键要素。初级保健 行为健康(PCBH)模式是将行为护理与初级保健相结合的领先模式， 行为健康顾问(BHC)与初级保健提供者(PCP)密切合作。PCMH，特别是 PCBH，有利于SBIRT的实施。 我们建议开发基于诊所的酒精滥用管理环境(AAME)系统，以促进 在PCMHs中实施SBIRT的所有阶段。AAME将提供优化、响应迅速的用户- 跨所有设备的体验，旨在帮助实践跟踪和监控患者的进展，帮助 共享临床决策流程，并与内部和外部专科资源协调护理 在整个SBIRT过程中。AAME将与EMR/EHR集成，还有助于满足帐单文档要求 医疗保险/医疗补助报销要求和PCMH认可要求。 第一阶段的目标包括：1)收集利益相关者对预期的系统功能、感知的有用性和 来自AUD患者、SBIRT提供者和研究人员的采用促进者/障碍通过访谈；2) 使用以用户为中心的设计和最新的数字医疗技术开发功能原型， 包括FHIR/SMART EMR集成的原型；以及3)进行两轮评估研究 无论是患者还是医疗服务提供者。第一轮将是基于设计原型的个人面试 早期反馈。第二轮将在PCMH的真实环境中进行为期一周的试点研究，以评估系统 在质量和数量上的可用性、有用性和可接受性。由以下人员组成的专家小组 相关课题的实践者和研究人员也将被召集来指导我们的研究和开发 方向。

Abstract The implementation of the Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol has shown to be effective in reducing alcohol use. However, real barriers to its implementation in primary care settings exist. The Patient-Centered Medical Home (PCMH) is a primary care model created to help improve population health, lower costs, and give patients better care experiences. Behavioral services are now a core aspect of PCMH, and substance abuse care is a key element of PCMH behavioral services. The Primary Care Behavioral Health (PCBH) model is the leading model integrating behavioral care into primary care with Behavioral Health Consultants (BHCs) working closely with Primary Care Providers (PCPs). PCMH, especially PCBH, is conducive to the implementation of SBIRT. We propose developing the clinic-based Alcohol Abuse Management Environment (AAME) system to facilitate the implementation of all stages of SBIRT in PCMHs. AAME will deliver an optimized, responsive user- experience across all devices and will be designed to help practices track and monitor patient progress, aid the shared clinical decision-making process, and coordinate care with internal and external specialty resources throughout the SBIRT process. AAME will integrate with EMRs/EHRs also help satisfy billing documentation requirements for Medicare/Medicaid reimbursements and PCMH Recognition requirements. Phase I aims include: 1) Collect stakeholder feedback on expected system features, perceived usefulness and adoption facilitators/barriers from AUD patients and SBIRT providers and researchers via interviews; 2) Develop the functional prototype using user-centered design and the latest digital health technologies, including prototyping on FHIR/SMART EMR integration; and 3) Conduct two rounds of the evaluation study with both patients and providers. The first round will be individual interviews based on design prototype for early feedback. The second round will be a one-week pilot study in a real PCMH setting to evaluate system usability, usefulness, and acceptability both qualitatively and quantitatively. An Expert Panel consisting of practitioners and researchers in related topics will also be convened to guide our research and development direction.