INtervention in Small Primary care practices to Implement Reduction in unhealthy alcohol usE (INSPIRE)

摘要 不健康的酒精使用是可预防死亡的主要原因，也是一系列社会和 健康问题，估计每年的经济影响为2490亿美元。尽管公共卫生问题严重 由于不健康饮酒的影响，全国的筛查率仍然很低。在伊利诺斯州和威斯康星州， 在中西部不健康饮酒水平最高的两个州，不到17%的患者接受 在初级保健环境中进行筛查，只有5%的报告重度饮酒的患者接受治疗。 由于缺乏有关筛查的临床教育，小诊所的有效筛查和治疗受到限制 酒精使用障碍的药物处方率低，转诊的可用性差 计划，以及难以将干预措施整合到现有的临床工作流程中。基于检查表的筛选 工具提供了一种简单、易于理解的策略，并已成功应用于医疗保健领域。 设置.在这个项目中，我们的目的是测试以办公室为基础的筛选的可行性和有效性， 在初级保健实践中，通过一个综合平台， 教育、实践促进和嵌入式EHR技术。该项目汇集了一个互补的 来自学术机构的专家团队，质量改进组织，基于实践的研究 网络和独立的研究组织，其中大多数人以前曾共同努力， 实施类似的以诊所为基础的干预措施，并辅之以实践促进，以改善心血管护理。 我们的具体目标是：1）开发和部署在线CME教育计划，以支持诊所 不良饮酒者行为干预与药物辅助治疗实施 使用和识别可能受益于进一步转诊的患者。2)进行一次随机化分步实践 在小型初级保健实践中进行楔形试验，以确定基于EHR的检查表的采用和有效性， 改善对不健康饮酒者的筛查和治疗。3)评估小的能力 我们地区的实践参与实践教育计划，并实施和维持标准 筛选和治疗方案，适用于电子健康记录，并确定因素， 使用定量和定性分析方法促进或阻碍改进和可持续性。一个 我们计划的重要成果将是一个强大的，可持续的教育和质量的提高 基础设施，可以部署和传播整个区域，以支持减少不健康的 饮酒

ABSTRACT Unhealthy alcohol use is a leading cause of preventable mortality and a risk factor for an array of social and health problems with an estimated annual economic impact of $249 billion. Despite the significant public health impact of unhealthy alcohol use, rates of screening across the country remain low. In Illinois and Wisconsin, two states with the highest levels of unhealthy alcohol use in the Midwest, less than 17% of patients receive screening in a primary care setting and only 5% of patients with reported heavy alcohol use receive treatment. Effective screening and treatment in small practices is limited by lack of clinician education around screening and management, low rates of prescribing medications for alcohol use disorder, poor availability of referral programs, and difficulty integrating interventions into existing clinical workflows. Checklist-based screening tools present a simple, easy to understand strategy and have been successfully applied within the healthcare setting. In this project, we aim to test the feasibility and effectiveness of office-based screening supported by behavioral and medication-based interventions in primary care practices, through an integrated platform of education, practice facilitation, and embedded EHR technology. The project brings together a complementary team of experts from academic institutions, a quality improvement organization, practice-based research networks and independent research organizations, a majority of whom have previously worked together to implement similar office-based interventions supported by practice facilitation to improve cardiovascular care. Our specific aims are to 1) Develop and deploy online CME education programs to support the in-clinic implementation of behavioral intervention and medication assisted treatment for people with unhealthy alcohol use and identify patients who may benefit from further referral. 2) Conduct a practice randomized stepped wedge trial in small primary care practices to determine the adoption and efficacy of an EHR-based checklist to improve screening and treatment for people with unhealthy alcohol use. 3) Evaluate the ability of small practices in our region to participate in practice education programs and implement and sustain standard screening and treatment protocols adapted for documentation in the EHR and identify the factors that facilitated or hindered improvement and sustainability using quantitative and qualitative analysis methods. An important outcome of our program will be a robust, sustainable education and quality improvement infrastructure that can be deployed and disseminated throughout our region to support reduction of unhealthy alcohol use.