Understanding practical alcohol measures in primary care to prepare for measurement-based care: Scaled EHR measures of alcohol use and DSM-5 AUD symptoms

了解初级保健中的实用酒精测量方法，为基于测量的护理做好准备：酒精使用和 DSM-5 AUD 症状的按比例 EHR 测量

• 批准号: 10516949
• 负责人: Kevin A Hallgren
• 金额: $ 4.61万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10516949
• 关键词: Accounting; Address; Adult; African American; Age; Alcohol consumption; Alcoholic Liver Cirrhosis; Alcohols; Blood Pressure; Caring; Cessation of life; Clinical; DSM-V; Data; Development Plans; Diagnosis; Doctor of Philosophy; Documentation; Electronic Health Record; Ensure; Ethnic Origin; Fellowship; Funding; Glass; Health; Health Disparities Research; Health Services Research; Health system; Healthcare; Hospitalization; Hour; Individual; Label; Language; Master' s Degree; Measurement; Measures; Medical; Mental Depression; Mentors; Mentorship; National Institute on Alcohol Abuse and Alcoholism; Outcome; Outcome Measure; Parents; Patient Care; Patient Outcomes Assessments; Patients; Postdoctoral Fellow; Primary Health Care; Principal Investigator; Probability; Provider; Publications; Questionnaires; Race; Reading; Research; Research Personnel; Risk; Sampling; Site; Socioeconomic Status; Statistical Models; Stigmatization; Structure; Subgroup; Symptoms; Talents; Testing; Text; Training; Universities; Visit; Washington; Work; Writing; addiction; alcohol measurement; alcohol misuse; alcohol screening; alcohol use disorder; base; career; career development; clinical care; data modeling; design; doctoral student; health care delivery; improved; innovation; intersectionality; meetings; mortality; novel; population health; programs; recruit; sex; skills; treatment services

SUMMARY. This Diversity Supplement would support Robert Ellis, MHA, a talented PhD student in the Health Systems and Population Health program at the University of Washington, who has outstanding potential as an independent NIAAA investigator. Mr. Ellis’ research focuses on how overlapping marginalized identities impact care for AUD. He has designed an innovative dissertation and recruited a strong committee of mentors. Kevin Hallgren, PhD, principal investigator (PI) of the Parent R33 Study (2021-2024) will be Mr. Ellis’s primary mentor; Katharine Bradley, MD, MPH, Site PI of the Parent R33 at Kaiser Permanente Washington, and Chair of Mr. Ellis’ Dissertation Committee, will be co-mentor. The Parent R33 aims to improve measures of unhealthy alcohol use and alcohol use disorders (AUD) documented in electronic health records (EHRs) as part of routine medical care. The R33 uses secondary data from over 700,000 adult primary care patients to evaluate the association of two scaled measures—the AUDIT-C alcohol screen and a validated DSM-5 Alcohol Symptom Checklist—with 5 health outcomes. Specific Aims of the Parent R33 are to evaluate: 1) the associations of AUDIT-C scores with blood pressure, depression, hospitalizations for alcohol-attributable conditions, all-cause hospitalizations, and death, 2) the associations between AUD symptoms and the 5 outcomes after accounting for AUDIT-C scores, and 3) the associations between changes in repeated AUDIT- C measures and changes in risk of the 5 health outcomes. The Parent R33 does not evaluate AUD diagnoses or use of stigmatized labels for AUD; nor does it evaluate outcomes across subgroups based on overlapping identities of sex, race/ethnicity, or socioeconomic status (SES). The proposed Diversity Supplement addresses these issues by evaluating factors associated with medical providers’ documentation of AUD diagnoses in the EHR during routine clinical care. The Specific Aims of the Proposed Diversity Supplement Research are: 1) to describe the probability of adult patients being diagnosed with AUD at primary care visits across subgroups based on the intersections of sex, race/ethnicity, and SES; 2) to describe the probability of being diagnosed with AUD across intersections of sex and race/ethnicity at similar levels of alcohol consumption and AUD symptoms; and 3) to describe the probability of providers selecting a stigmatized label in the EHR when diagnosing AUD based on the intersection of sex and race/ethnicity. Mr. Ellis’ Career Development and Mentoring Plan will support Mr. Ellis as he develops: 1) expertise and skills in alcohol-related health services research and applied disparities research; 2) progressive independence as an investigator, demonstrated by at least 5 publications (3 first-authored); and 3) applies for and obtains a competitive post-doctoral fellowship or an F32 individual fellowship. Mr. Ellis will achieve these objectives via structured and applied training, hands- on mentoring (≥3 hours a week) by Drs. Hallgren and Bradley, plus support from 4 content mentors. Impact. The proposed supplement will inform all Aims of the R33 focused on alcohol-attributable conditions.

概括。这种多样性补充剂将支持罗伯特·埃利斯（Robert Ellis），MHA，一名才华横溢的博士生。 华盛顿大学的系统和人口健康计划，他作为一名 独立的NIAAA研究员。埃利斯先生的研究重点是边缘化身份如何影响 关心aud。他设计了创新的论文，并招募了强大的导师委员会。凯文 Hallgren，博士，父母R33研究（2021-2024）的首席研究员（PI）将是Ellis先生的主要 导师;医学博士Katharine Bradley，MPH，Kaiser Permanente Washington的家长R33的Site PI和椅子 埃利斯先生的论文委员会将成为联合委员。父母R33旨在改善不健康的措施 电子健康记录（EHR）中记录的酒精使用和酒精使用障碍（AUD） 常规医疗保健。 R33使用来自700,000多名成人初级保健患者的二级数据来评估 两种尺度措施的关联 - 审计-C酒精屏幕和经过验证的DSM-5酒精 症状清单 - 具有5个健康结果。父r33的具体目的是评估：1） 审计-C分数与血压，抑郁，酒精饮酒的住院 条件，全因住院和死亡，2）AUD症状与5个症状之间的关联 考虑了审计-C分数后的结果，以及3）重复审核的变化之间的关联 - C衡量5种健康结果的风险和变化。家长R33未评估AUD诊断 或使用污名的标签进行aud；它也不基于重叠的子组评估结果 性别，种族/种族或社会经济地位（SES）的身份。拟议的多样性补充地址 这些问题通过评估与医疗提供者在 常规临床护理期间的EHR。拟议多样性补充研究的具体目的是：1） 描述在子组跨初级保健访问时被诊断为AUD的成年患者的可能性 基于性别，种族/种族和SES的交集； 2）描述被诊断的概率 在性别和种族/种族的交叉点上，饮酒水平和AUD的aud 符号； 3）描述提供者在EHR中选择污名标签的概率 根据性别与种族/种族的交集诊断AUD。埃利斯先生的职业发展和 指导计划将在埃利斯（Ellis）发展时支持：1）与酒精相关的健康服务方面的专业知识和技能 研究和应用分布研究； 2）作为研究者的渐进独立性，由AT证明 至少有5个出版物（第3个首次作者）； 3）申请并获得了竞争性博士后奖学金或 F32个人奖学金。埃利斯先生将通过结构化和应用的培训，传手实现这些目标 DRS的心理（每周≥3个小时）。 Hallgren和Bradley，以及4位内容导师的支持。影响。 拟议的补充剂将为R33的所有目的提供介绍，重点介绍了酒精饮食条件。