A Telehealth Intervention to Increase Screening and Treatment for Alcohol Use Disorder

摘要 RIA Health是一家全国性的早期远程医疗和技术公司， 结合客观的饮酒方法(每天两次)治疗酒精使用障碍 呼气测定仪通过我们的应用程序进行测量)，医生监督的药物，以及团体和 个人教练-Ria治疗平台。RIA已经招募了4500多名患者， 在45个州提供，并由主要保险公司承保。RIA已经积累了超过 来自入选患者的30万呼气测定仪显示酒精减少 在1个月时使用50%，在12个月时使用75%。平均留存时间为10个月。 与酒精相关的肝病的发病率和负担正在增加。没有 自动化方法，专门筛选早期与酒精相关的肝病。在这 我们将使用一个大型电子健康记录系统(斯坦福大学的Epic 健康)，以确定肝功能检测升高的患者患糖尿病的风险增加 隐匿性酒精使用障碍。斯坦福大学史诗记录的可行性分析确定 56,460名肝功能(AST、ALT、GGT)升高的成人患者，他们可能是 为这项研究进行了筛选。肝功能检测升高的患者将被一位诚实的人邀请 经纪人“接受酒精使用障碍的筛查，如果存在酒精使用障碍，则 通过Ria接受治疗。 我们假设有酒精使用障碍和肝功能升高的患者 否则不会寻求治疗的人将被激励从事治疗。我们会 在124名受试者中进行随机等待名单对照研究，以证明 瑞亚治疗平台。将评估一套全面的成果衡量标准，包括 在最后4周内没有大量饮酒的受试者被定义为主要饮酒者的百分比 结果。 该项目有几个创新的特点。它是第一个使用大规模筛选的 大型电子健康记录系统，用于识别潜在的酒精使用障碍病例 进行异常肝功能检测，并让他们参与治疗。考虑到发病率和 酒精使用障碍的死亡率，早期识别和参与这些患者的新方法 都是迫切需要的。我们还将进行RIA的第一个随机对照试验 治疗平台，为付款人提供关键的验证。

Abstract Ria Health is a nationally scaling early-stage telemedicine and technology company that treats alcohol use disorder with a combination of objective measures of drinking (twice daily breathalyzer measures through our app), physician-supervised medications, and group and individual coaching - the Ria Treatment Platform. Ria has enrolled more than 4,500 patients, is available in 45 states, and is covered by major insurers. Ria has accumulated more than 300K breathalyzer measures from enrolled patients that demonstrate a reduction in alcohol use of 50% at 1 month and 75% at 12 months. Mean retention in treatment is 10 months. The incidence and burdens of alcohol-associated liver disease are growing. There are no automated methods that screen specifically for early alcohol-associated liver disease. In this project we will use a large electronic health record system (Epic at Stanford University Health) to identify patients with elevated liver function tests who are at increased risk for occult alcohol use disorder. A feasibility analysis of Epic records at Stanford identified >56,460 adult patients with elevated liver function tests (AST, ALT, GGT) who could be screened for this study. Patients with elevated liver function tests will be invited by an “honest broker” to be screened for alcohol use disorder and, if alcohol use disorder is present, to receive treatment through Ria. We hypothesize that patients with alcohol use disorder and elevated liver function tests who would otherwise not seek treatment will be motivated to engage in treatment. We will conduct a randomized wait-list controlled study in 124 subjects to demonstrate the efficacy of the Ria Treatment Platform. A comprehensive set of outcome measures will be assessed, with percent of subjects without heavy drinking in the final 4 weeks defined as the primary outcome. The project has several innovative features. It is the first to use mass screening of a large electronic health records system to identify potential cases of alcohol use disorder with abnormal liver function tests and to engage them in treatment. Given the morbidity and mortality of alcohol use disorder, new methods to identify and engage these patients earlier are urgently needed. We will also conduct the first randomized controlled trial of the Ria Treatment Platform, providing crucial validation for payers.