IAMSBIRT: Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers

IAMSBIRT：在国家儿科创伤中心队列中实施酒精滥用 SBIRT

• 批准号: 10170926
• 负责人: Michael J Mello
• 金额: $ 18.75万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10170926
• 关键词: Address; Administrative Supplement; Adolescent; Adopted; Alcohol or Other Drugs use; American College of Surgeons; Analgesics; COVID-19 pandemic; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Clinical; Counseling; Data; Drug Screening; Drug usage; Effectiveness; Electronic Health Record; Elements; Enrollment; Feedback; Funding; Goals; Health Personnel; Hospitals; Intervention; Laboratories; Leadership; Lifting; Measures; Mediating; Nurses; Organizational Change; Participant; Patient Self-Report; Patients; Pediatric cohort; Performance; Pharmaceutical Preparations; Pharmacotherapy; Protocols documentation; Provider; Public Health; Readiness; Reporting; Research; Research Design; Sampling; Sampling Studies; Science; Services; Site; Social Workers; Technology Transfer; Time; Training; United States Substance Abuse and Mental Health Services Administration; Visit; addiction; adolescent patient; alcohol and other drug; alcohol misuse; alcohol screening; base; brief intervention; care providers; clinical care; cohort; design; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; evidence base; follow-up; implementation science; implementation strategy; improved; injured; pediatric trauma; prescription pain reliever; public health relevance; screening; screening, brief intervention, referral, and treatment; trauma centers

PROJECT SUMMARY The American College of Surgeons mandate universal screening for alcohol misuse and delivery of a brief intervention for those screening positive as a requirement for certification as a level one trauma center. Though this requirement has been mandated for over a decade, its implementation has been challenging, especially for pediatric trauma centers. Our currently funded study, IAMSBIRT, tests the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug (AOD) use in pediatric trauma centers through a Type III hybrid effectiveness-implementation trial. This goal is accomplished through: Primary Aim: Evaluate the effectiveness of the SSL implementation strategy in increasing fidelity of SBIRT delivery at pediatric trauma centers, relative to usual implementation; Secondary Aim 1: Evaluate whether readiness for organizational change mediates the influence of the SSL implementation strategy on implementation effectiveness (i.e., fidelity of SBIRT delivery); Secondary Aim 2: Evaluate the effect of the SSL implementation strategy on improving patient linkage to appropriate care (i.e., continued AOD discussion with primary care provider and/or AOD treatment) following discharge from pediatric trauma centers; and Exploratory Aim: Examine the integration of counseling regarding the use of prescription pain relievers into SBIRT delivery with injured adolescent patients who screen positive for AOD use. Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers receive the SSL implementation strategy. At six distinct time points, each site provides data from a sample of thirty electronic health records (EHRs); a subset of adolescents report on fidelity of intervention delivery and linkage to care. Clinical staff from each pediatric trauma center report on organizational readiness for implementation at three distinct time points. The administrative supplement requested will expand our EHR review to be of all admitted adolescents across all wedges (including those already occurred) to examine providers’ clinical notes 30 days post discharge for evidence of linkage to care (AOD follow up discussions/ AOD treatment) after the trauma center visit. This change is necessary to effectively examine Secondary Aim 2 given changes in the research protocol due to the COVID-19 pandemic. Results of this study will demonstrate that a highly scalable implementation strategy will improve the fidelity (i.e., the consistency and quality) of SBIRT delivery in pediatric trauma centers.

项目摘要 美国外科医生学院要求普遍筛查滥用酒精和交付 对于那些筛查积极的人的干预措施作为认证作为一级创伤中心的要求。尽管 这项要求已被授权十多年，其实施受到挑战，尤其是针对 小儿创伤中心。我们目前资助的研究Iamsbirt测试了全面的有效性 实施策略，以增加对酒精和其他药物（AOD）使用的实施 小儿创伤以III型混合有效性试验为中心。实现了这个目标 通过：主要目的：评估SSL实施策略在提高忠诚度的有效性 相对于通常的实施，小儿创伤中心的SBIRT分娩；次要目标1：评估 准备组织变革的准备是否介导了SSL实施策略对 实施有效性（即Sbirt交付的保真度）；次要目标2：评估SSL的效果 实施策略以改善患者与适当护理的联系（即，与持续的AOD讨论 小儿创伤中心出院后，初级保健提供者和/或AOD治疗）；和 探索目的：检查有关使用处方止痛药的咨询的整合 SBIRT分娩，受伤的青少年患者，他们的AOD使用阳性。利用阶梯楔 设计是一个由10个儿科创伤中心组成的国家队列，获得了SSL实施策略。在六个截然不同的地方 时间点，每个站点提供了来自30个电子健康记录（EHR）样本的数据；一个子集 青少年报告了干预交付和与护理联系的忠诚。每个小儿的临床人员 创伤中心关于在三个不同时间点实施的组织准备就绪的报告。这 要求的行政补充将扩大我们的EHR审查，以成为所有公认的青少年 楔子（包括已经发生的楔子）检查了出院后30天的提供者的临床笔记的 创伤中心访问后，与护理联系的证据（AOD后续讨论/ AOD治疗）。这 由于研究方案中的更改，必须有效地检查次要目标2的必要变化。 2019冠状病毒病大流行。这项研究的结果将表明，高度可扩展的实施策略将 提高小儿创伤中心的Sbirt递送的保真度（即一致性和质量）。