Alcohol Use Disorder Treatment Simulation: Modeling treatment impacts on alcohol-related disparities

酒精使用障碍治疗模拟：模拟治疗对酒精相关差异的影响

• 批准号: 10370506
• 负责人: Katherine J. Karriker-Jaffe
• 金额: $ 76.11万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-10 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10370506
• 关键词: Accident and Emergency department; Address; Alcohol consumption; Alcoholics Anonymous; Alcohols; California; Caring; Clinic; Communities; Complex; Continuity of Patient Care; Costs and Benefits; County; Data; Development; Dimensions; Distal; Economics; Ethnic Origin; Evaluation; Evidence based practice; Federally Qualified Health Center; Funding; Future; Gender; Geographic Locations; Geography; Goals; HIV; Health Personnel; Health Services; Health Services Accessibility; Heavy Drinking; Improve Access; Individual; Intervention; Investigation; Language; Literature; Medicaid; Mental Health; Methods; Minority Groups; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Pattern; Persons; Pharmaceutical Preparations; Policies; Population; Prenatal care; Primary Health Care; Publishing; Race; Recovery; Recovery Support; Research; Resources; Role; Rural; Services; Severities; Slide; Socioeconomic Status; Specific qualifier value; Spottings; Statistical Computing; Statistical Models; Subgroup; Surveys; System; Testing; Texas; Time; United States; Violence; Vulnerable Populations; Woman; alcohol availability; alcohol related problem; alcohol use disorder; barrier to care; base; college; cost; cost effective; cost effective intervention; cost effectiveness; cost estimate; disparity reduction; drinking; health care availability; health care service utilization; health care settings; health disparity; improved; insight; intervention effect; medical specialties; medication-assisted treatment; models and simulation; opioid epidemic; preventable death; programs; racial and ethnic; reduced alcohol use; scale up; screening; screening and brief intervention; screening, brief intervention, referral, and treatment; service intervention; simulation; sobriety; social; socioeconomics; theories; treatment disparity; treatment program; trend; underserved area; Accident and Emergency department; Address; Alcohol consumption; Alcoholics Anonymous; Alcohols; California; Caring; Clinic; Communities; Complex; Continuity of Patient Care; Costs and Benefits; County; Data; Development; Dimensions; Distal; Economics; Ethnic Origin; Evaluation; Evidence based practice; Federally Qualified Health Center; Funding; Future; Gender; Geographic Locations; Geography; Goals; HIV; Health Personnel; Health Services; Health Services Accessibility; Heavy Drinking; Improve Access; Individual; Intervention; Investigation; Language; Literature; Medicaid; Mental Health; Methods; Minority Groups; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Pattern; Persons; Pharmaceutical Preparations; Policies; Population; Prenatal care; Primary Health Care; Publishing; Race; Recovery; Recovery Support; Research; Resources; Role; Rural; Services; Severities; Slide; Socioeconomic Status; Specific qualifier value; Spottings; Statistical Computing; Statistical Models; Subgroup; Surveys; System; Testing; Texas; Time; United States; Violence; Vulnerable Populations; Woman; alcohol availability; alcohol related problem; alcohol use disorder; barrier to care; base; college; cost; cost effective; cost effective intervention; cost effectiveness; cost estimate; disparity reduction; drinking; health care availability; health care service utilization; health care settings; health disparity; improved; insight; intervention effect; medical specialties; medication-assisted treatment; models and simulation; opioid epidemic; preventable death; programs; racial and ethnic; reduced alcohol use; scale up; screening; screening and brief intervention; screening, brief intervention, referral, and treatment; service intervention; simulation; sobriety; social; socioeconomics; theories; treatment disparity; treatment program; trend; underserved area

PROJECT SUMMARY/ABSTRACT Excessive drinking results in tremendous economic and social costs and is a leading cause of preventable death in the US. Only a small minority of people with alcohol use disorder (AUD) receive appropriate services, and there are large disparities in access to alcohol health services for people based on race/ethnicity, gender, socioeconomic status, and urbanicity. The proposed study will answer pressing questions about how to reduce disparities in access, using simulation modeling to examine whether universal increases in access to evidence-based practices (EBPs) such as screening, brief intervention, and referral to treatment (SBIRT) or medication-assisted treatment can reduce disparities, or whether more targeted efforts to improve access are needed to reach high-priority population subgroups. Simulation models are well-suited for identifying unintended consequences of interventions implemented in complex systems, as well as outcomes that may occur years after implementation. By projecting intervention effects across population subgroups over time, simulation modeling can help identify and prioritize types of alcohol health services interventions to reduce AUD disparities. Although simulation methods are being used to address the opioid crisis, to date there is no published simulation model comprehensively describing the continuum of alcohol health services in relation to AUD disparities. The proposed study fills this gap by simulating effects of increased access to alcohol health services across the continuum of care from SBIRT, to specialty care (including AUD medications) and informal treatment (including 12-step groups like Alcoholics Anonymous), in relation to health disparities. First, we will build and calibrate a microsimulation model of alcohol health services for people with mild, moderate, and severe AUD, guided by a conceptual model that includes barriers to treatment at the individual, organizational, community, and policy levels. Next, we will use a geographically situated simulated population representing the large, demographically and geographically diverse states of California and Texas to make long-term projections for AUD severity and recovery for key population subgroups over time. Finally, informed by theories of healthcare access and utilization, we will project changes in AUD treatment disparities under several enhanced conditions to identify the mix and distribution of services that would best reduce disparities, and we estimate costs and benefits of improved service access. Study Aims are to assess effects of (1) universal implementation of EBPs in traditional and non-traditional settings and (2) improving accessibility, availability, affordability, and acceptability of alcohol health services on disparities, and to (3) estimate cost and cost-effectiveness of these changes. Results will provide detailed information to inform service planning by states, counties, and communities to improve health services, including projections for how and where to intervene in a cost- effective manner to reduce the burden of AUD and increase long-term recovery for vulnerable populations.

项目摘要/摘要 过度饮酒会导致巨大的经济和社会成本，并且是可预防的主要原因 在美国死亡。只有少数酒精饮用障碍（AUD）获得适当的人 服务，并且基于 种族/种族，性别，社会经济地位和城市化。拟议的研究将回答紧迫 有关如何减少访问中差异的问题，使用模拟建模来检查是否是否 普遍增加获得基于证据的实践（EBP），例如筛查，简短干预和 转介治疗（SBIRT）或药物辅助治疗可以减少差异，或者是否更多 为了达到高优先级人口亚组，需要采取针对性的访问努力。模拟 模型非常适合确定复杂中实施的干预措施的意外后果 系统以及实施后几年可能发生的结果。通过预测干预效果 随着时间的流逝，整个人群亚组，模拟建模可以帮助识别和优先考虑酒精类型 卫生服务干预措施以减少AUD差异。尽管模拟方法已用于 解决阿片类药物危机，迄今为止，还没有全面描述的模拟模型 酒精保健服务与AUD差异有关的连续性。拟议的研究通过 模拟在SBIRT连续护理中增加酒精卫生服务的影响， 进行专业护理（包括AUD药物）和非正式治疗（包括12步组 关于健康差异的酗酒者匿名）。首先，我们将构建和校准微观仿真 在概念的指导下，为具有轻度，中度和严重aud的人提供酒精卫生服务模型 包括在个人，组织，社区和政策层面的治疗障碍的模型。下一个， 我们将使用代表大型，人口统计和 在加利福尼亚和德克萨斯州地理上多样化的州，以对AUD严重性进行长期预测和 随着时间的推移，关键人口亚组的恢复。最后，由医疗保健访问理论和 利用率，我们将在几个增强条件下投射AUD治疗差异的变化，以识别 服务的组合和分配最能减少差异的服务，我们估计成本和收益 改进的服务访问。研究目的是评估（1）在 传统和非传统设置，以及（2）提高可访问性，可用性，负担能力以及 酒精卫生服务在差异方面的可接受性，以及（3）估计成本和成本效益 这些变化。结果将提供详细的信息，以告知各州，县和 改善卫生服务的社区，包括有关如何以及在何处干预成本的预测 - 减轻AUD负担并增加弱势群体的长期恢复的有效方式。