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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要过度饮酒会造成巨大的经济和社会成本，是可预防的主要原因在美国死亡。只有一小部分患有酒精使用障碍 (AUD) 的人接受适当的治疗服务，并且人们在获得酒精健康服务方面存在很大差异种族/民族、性别、社会经济地位和城市化程度。拟议的研究将回答紧迫的问题有关如何减少访问差异的问题，使用模拟模型来检查是否普遍增加获得循证实践（EBP）的机会，例如筛查、简短干预和转诊治疗 (SBIRT) 或药物辅助治疗可以减少差异，或者是否更多需要有针对性地努力改善获取机会，以惠及高度优先的人口亚群体。模拟模型非常适合识别在复杂的环境中实施干预措施的意外后果系统，以及实施数年后可能出现的结果。通过预测干预效果随着时间的推移，模拟模型可以帮助识别和优先考虑酒精类型卫生服务干预措施，以减少澳元差异。尽管模拟方法被用来解决阿片类药物危机，迄今为止还没有公开的模拟模型全面描述与澳元差异相关的酒精健康服务的连续性。拟议的研究填补了这一空白模拟在 SBIRT 的连续护理过程中增加获得酒精健康服务的影响，专业护理（包括 AUD 药物）和非正式治疗（包括 12 步组，例如戒酒互诫协会），与健康差异有关。首先，我们将构建并校准微观模拟为轻度、中度和重度 AUD 患者提供酒精健康服务的模式，以概念为指导模型包括个人、组织、社区和政策层面的治疗障碍。下一个，我们将使用一个地理位置模拟人口来代表大量的、人口统计和加利福尼亚州和德克萨斯州等地理位置不同的州对澳元严重程度和随着时间的推移，关键人口亚群的恢复。最后，根据医疗保健获取理论和利用情况下，我们将预测在几种增强条件下澳元待遇差异的变化，以确定最能减少差异的服务组合和分配，我们估计了以下服务的成本和收益改善服务准入。研究目的是评估 (1) 普遍实施 EBP 的效果传统和非传统环境；(2) 提高可及性、可用性、可负担性，以及酒精健康服务的可接受性差异，以及 (3) 估计酒精健康服务的成本和成本效益这些变化。结果将提供详细信息，为各州、县和州的服务规划提供信息社区改善卫生服务，包括预测如何以及在何处干预成本减轻澳元负担并促进弱势群体长期康复的有效方式。