AAME: Implementing SBIRT in Patient-Centered Medical Homes

摘要 针对NOT-AA-20-011，本行政副刊将加强筛查、简短干预 和家长拨款(1R43AA028453-01)中建议的转诊到治疗(SBIRT)支持解决方案，以帮助 打击危险饮酒行为和新冠肺炎的危险组合，并解决新的 新冠肺炎时代初级保健实施SBIRT面临的挑战。 实施SBIRT被证明在减少酒精使用方面是有效的。然而，ITS的真正障碍是 在初级保健环境中实施。以患者为中心的医疗之家是一种初级保健 创建的模式有助于改善人口健康，降低成本，并为患者提供更好的护理体验。 行为服务现在是PCMH的核心方面，药物滥用护理是PCMH的关键要素 行为服务。初级保健行为健康(PCBH)模式是整合 将行为护理转变为初级护理。PCMH，尤其是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旨在帮助实践跟踪和 监控患者进程，协助共享的临床决策过程，并与内部协调护理 以及整个SBIRT过程中的外部专业资源。AAME将与EHR集成，并提供帮助 满足Medicare/Medicaid报销和PCMH认可的文件要求。在……里面 作为补充，我们将通过自我报告措施来增强AAME，以具体解决患者的风险 酗酒、柯萨奇病毒感染和传播的行为。我们还将考虑到 由于COVID相关政策的限制，Practice的临床工作流程和SBIRT方案。 家长拨款的第一阶段目标是：1)收集利益相关者对预期系统功能的反馈， AUD患者和SBIRT提供商的感知有用性和采用促进者/障碍 通过访谈研究人员；2)使用以用户为中心的设计和最新的 数字健康技术，包括FHIR/智能电子病历集成的原型；以及3)进行两轮 对患者和提供者的评估研究。第一轮将是基于以下因素的个人面试 为早期反馈设计原型。第二轮将在PCMH的真实环境中进行为期一周的试点研究，以 评估系统的可用性、有用性和可接受性。在本增刊中，我们将延长采访的时间 目标1帮助了解新冠肺炎大流行与饮酒行为/澳元之间的关系，以及 新冠肺炎对SBIRT方案和临床工作流程的影响。我们还将实施一套新冠肺炎 目标2中的具体筛查措施，为初级保健实践提供必要的工具，以评估新冠肺炎 风险和影响，所有这些都在集成的SBIRT支持环境中。

Abstract In response to NOT-AA-20-011, this administrative supplement will enhance the Screening, Brief Intervention and Referral to Treatment (SBIRT) support solution proposed in the parent grant (1R43AA028453-01) to help combat the dangerous combination of risky alcohol use behaviors and COVID-19, and to address the new challenges to SBIRT implementation in primary care during the COVID-19 era. The implementation of SBIRT 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. 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 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 EHRs and also help satisfy the documentation requirements for Medicare/Medicaid reimbursements and for PCMH Recognition. In this supplement, we will enhance AAME with self-report measures to specifically address patients’ risky behaviors for alcohol use and for COVID infection and transmission. We will also account for changes in the practice’s clinical workflows and SBIRT protocol due to COVID-related policy restrictions. The Phase I aims of the parent grant are: 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. In this supplement, we will extend the interviews in Aim 1 to help understand the relationship between the COVID-19 pandemic and drinking behavior/AUD, and the impacts of COVID-19 on SBIRT protocol and clinic workflows. We will also implement a suite of COVID-19 specific screening measures in Aim 2 to give primary care practices the necessary tools to assess COVID-19 risks and impacts, all within an integrated SBIRT support environment.