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.

项目概要 美国外科医生学会要求对酗酒情况进行普遍筛查并提供简短的报告 不过，对那些筛查呈阳性的人进行干预是获得一级创伤中心认证的要求。 这一要求已经强制实施了十多年，其实施一直具有挑战性，特别是对于 我们目前资助的研究 IAMSBIRT 测试了一项综合性研究的有效性。 加强针对酒精和其他药物（AOD）使用的 SBIRT 实施的实施战略 儿科创伤中心通过 III 型混合有效性实施试验实现了这一目标。 通过： 主要目标：评估 SSL 实施策略在提高保真度方面的有效性 儿科创伤中心的 SBIRT 实施，相对于通常的实施情况；次要目标 1：评估 组织变革的准备是否会调节 SSL 实施策略对组织变革的影响 实施有效性（即 SBIRT 交付的保真度）；次要目标 2：评估 SSL 的效果 改善患者与适当护理联系的实施策略（即与 从儿科创伤中心出院后，初级保健提供者和/或 AOD 治疗；以及 探索性目标：检查将有关使用处方止痛药的咨询整合到 使用阶梯楔对 AOD 使用筛查呈阳性的受伤青少年患者进行 SBIRT 治疗。 根据设计，全国 10 个儿科创伤中心接受了 SSL 实施策略。 时间点，每个站点提供来自 30 个电子健康记录 (EHR) 子集的样本的数据； 青少年报告了干预实施的忠诚度以及每个儿科临床工作人员的联系。 创伤中心关于在三个不同时间点实施的组织准备情况的报告。 请求的行政补充将把我们的电子病历审查范围扩大到所有被录取的青少年 出院后 30 天检查提供者的临床记录 创伤中心访问后与护理的联系（AOD 后续讨论/AOD 治疗）的证据。 由于研究方案发生变化，为了有效地检验次要目标 2，有必要进行更改 COVID-19 大流行的研究结果将证明高度可扩展的实施策略将有效。 提高儿科创伤中心 SBIRT 实施的保真度（即一致性和质量）。