Quality of Alcohol-Related Care Received: Missed Opportunities, Disparities and Impacts of Health Reform

摘要：接受酒精相关护理的质量：错失的机会、差距和影响 关于医疗改革的问题 大约20年前，据估计，患有酒精使用障碍(AUD)的美国人 只有10%的时间关心。这给酒精服务提供商和政策制定者敲响了警钟 在美国，无节制的有害饮酒的巨大影响。过度饮酒是导致 美国人中可预防的死亡，每4个美国成年人中就有1人超过NIAAA推荐的饮酒量 极限。此外，在青壮年以后持续大量饮酒，在较晚发病的时候， AUD的持续性和复发率以及与酒精相关的发病率和死亡率。迫切需要解决的问题 不健康饮酒促使初级保健中的酒精筛查和短暂干预(ASBI)和认知 AUD的慢性、复发性的研究将注意力集中在治疗的参与性、滞留性和 酒精药物治疗的完成和承诺。然而，新的研究表明ASBI的质量 与临床指导方针相去甚远，而且在获得药物治疗方面可能存在差异。现在，更多 与以往任何时候相比，医疗质量和差距是美国医疗保健提供者和 政策制定者，并作为卫生改革举措的目标，以改善患者结局和降低医疗成本。 这个持续的中心项目旨在通过使用国家调查和行政管理来阐明这些问题 调查整个酒精服务系统中与酒精相关的护理质量和差异的数据，来自 从预防到治疗。研究的目的是：1)评估错失的机会的规模和严重性 为不健康饮酒和AUD提供适当的ASBI；2)审查AUD的药物治疗收据； 以及3)评估卫生改革对接受适当的ASBI、完成酒精治疗、 和综合护理(由澳大利亚和特别是澳大利亚的人接受特殊治疗和一般保健 健康并存)。这项以人群为基础的研究将利用我们团队研究饮酒的独特专业知识 使用国家数据集的模式、酒精问题、酒精服务利用和相关差距；适用 传统的分析和准实验技术以及尖端的因果推理方法； 采用综合概念框架来强调护理中的不平等如何在整个酒精行业累积起来 服务体系。通过定义基于酒精和健康并存的护理需求，这项研究将强调 未能为不健康饮酒和澳门氏症提供优质护理对健康的影响。调查结果有助于 鼓励临床医生、医疗保健管理人员、治疗提供者和政策制定者努力增加和 改善与酒精有关的护理和平等机会。

ABSTRACT: Quality of Alcohol-related Care Received: Missed Opportunities, Disparities and Impacts of Health Reform Nearly 20 years ago it was estimated that Americans with an alcohol use disorder (AUD) receive recommended care only 10% of the time. This was a striking, wake-up call to alcohol services providers and policymakers given the tremendous impact of unchecked harmful drinking in the US. Excessive drinking is a leading cause of preventable death among Americans, with 1 of every 4 US adults exceeding NIAAA's recommended drinking limits. Moreover, there are disparities in on-going heavy drinking beyond young adulthood, in later onset, persistence and recurrence of AUD, and in alcohol-related morbidity and mortality. The pressing need to address unhealthy drinking has motivated alcohol screening and brief intervention (ASBI) in primary care, and recognition of the chronic, relapsing nature of AUD has focused attention on treatment engagement, retention, and completion and the promise of alcohol pharmacotherapy. Yet new research suggests that the quality of ASBI falls far short of clinical guidelines, and that there may be disparities in access to pharmacotherapy. Now, more than ever, healthcare quality and disparities are key issues for US healthcare providers and policymakers, and targeted by health reform initiatives to improve patient outcomes and reduce medical costs. This Continuing Center Project aims to shed light on these issues by using national survey and administrative data to investigate alcohol-related care quality and disparities across the alcohol services system, from prevention to treatment. Study Aims are to: 1) Assess the magnitude and severity of missed opportunities for providing appropriate ASBI for unhealthy drinking and AUD; 2) Examine receipt of pharmacotherapy for AUD; and 3) Assess the effects of health reform on the receipt of appropriate ASBI, completion of alcohol treatment, and integrated care (receipt of specialty treatment and general health care by persons with AUD and especially health comorbidities). This population-based study will leverage our team's distinctive expertise studying drinking patterns, alcohol problems, alcohol services utilization and related disparities using national data sets; apply traditional analytic and quasi-experimental techniques as well as cutting-edge causal inference methods; and employ an integrative conceptual framework to highlight how inequities in care can add up across the alcohol services system. By defining the need for care based on alcohol and health comorbidities, this study will highlight the health implications of failing to provide quality care for unhealthy drinking and AUD. Findings can help to stimulate efforts by clinicians, healthcare administrators, treatment providers and policymakers to increase and improve alcohol-related care and equitable access.