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: 10430304
• 负责人: Michael J Mello
• 金额: $ 18.71万
• 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 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10430304
• 关键词: Address; Adolescent; Adopted; Adoption; Alcohol or Other Drugs use; American College of Surgeons; Analgesics; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Clinical; Computerized Medical Record; Counseling; Data; Data Collection; Development; Drug Screening; Drug usage; Effectiveness; Elements; Feedback; Funding; Goals; Health Personnel; Hospitals; Intervention; Laboratories; Leadership; Mediating; Methods; Nurses; Opioid; Organizational Change; Patients; Pediatric cohort; Performance; Pharmaceutical Preparations; Pharmacotherapy; Provider; Public Health; Recording of previous events; Reporting; Research; Risk; Science; Services; Site; Social Workers; Source; Technology Transfer; Time; Training; Trauma patient; Treatment Protocols; United States Substance Abuse and Mental Health Services Administration; addiction; adolescent patient; alcohol and other drug; alcohol misuse; alcohol screening; alcohol screening and brief intervention; base; brief intervention; care providers; clinical care; cohort; design; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; evidence base; implementation research; implementation science; implementation strategy; implementation study; implementation trial; improved; injured; opioid misuse; organizational readiness; pain patient; patient oriented; pediatric trauma; prescription pain reliever; public health relevance; screening; screening, brief intervention, referral, and treatment; social organization; trauma centers; treatment adherence

PROJECT SUMMARY In 2006, the American College of Surgeons (ACS) adopted a requirement for certification as a level one trauma center that mandated universal screening for alcohol misuse and delivery of a brief intervention for those screening positive. Though this requirement has been mandated for a decade, its implementation has been challenging, especially for pediatric trauma centers. Our research team completed a CDC funded implementation study supporting seven pediatric trauma centers' compliance with the ACS requirement by developing and implementing an institutional alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol for adolescent trauma patients. A mixed-methods approach indicated that SBIRT adoption rates increased at all sites; however, providers' fidelity to the SBIRT intervention was variable, and providers reported a number of barriers to SBIRT implementation. The goal of this application is to conduct a fully powered Type III hybrid effectiveness-implementation trial to test the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug use in pediatric trauma centers. Our implementation strategy is based on the Science to Service Laboratory (SSL), an approach developed by the SAMHSA-funded Addiction Technology Transfer Centers (ATTCs) that consists of the same three core elements (i.e., didactic training + performance feedback + leadership coaching) used in our CDC study. Based on feedback from the CDC study, two enhancements were made to the SSL strategy: 1) integration of the intervention into the electronic medical record as a means of improving SBIRT adherence; and 2) development of separate training tracks for nurses, social workers and organizational leaders to meet the unique needs of each group. In addition, we integrate counseling around the use of prescription pain relievers into the SBIRT intervention as an Exploratory Aim, since most pediatric trauma center patients are discharged on pain medication and patients with a history of AOD use are at elevated risk of opioid misuse. Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers will receive the SSL implementation strategy. Data collection for this study relies on multiple sources. At six distinct time points, each of the 10 sites will provide data from 30 EMR charts (n = 1800 charts in total). A subset of adolescents will also report on fidelity of intervention delivery and linkage to care (i.e., continued AOD discussion and/or treatment with a primary care provider) 1 month post hospital discharge. In addition, nurses, social workers, and leaders from each pediatric trauma center will report on organizational readiness for implementation at three distinct time points. Results of this study will demonstrate that a highly scalable implementation strategy, adapted for pediatric trauma centers from the results of our mixed-methods implementation trial, will improve the fidelity (i.e., the consistency and quality) of SBIRT delivery in pediatric trauma centers.

项目概要 2006 年，美国外科医生学会 (ACS) 通过了一级创伤认证要求 该中心要求对酗酒者进行普遍筛查，并为这些人提供简短的干预 筛查呈阳性。尽管这一要求已经强制实施了十年，但其实施却一直进展缓慢。 具有挑战性，尤其是对于儿科创伤中心。我们的研究团队完成了 CDC 资助的 支持七个儿科创伤中心遵守 ACS 要求的实施研究 制定和实施机构酒精筛查、简短干预和转诊治疗 (SBIRT) 青少年创伤患者方案。混合方法表明 SBIRT 的采用 所有站点的费率均有所提高；然而，提供者对 SBIRT 干预的忠诚度是可变的，并且提供者 报告了 SBIRT 实施的一些障碍。该应用程序的目标是进行全面的 动力型 III 混合动力实施试验，测试综合方案的有效性 加强儿科酒精和其他药物使用 SBIRT 实施的实施策略 创伤中心。我们的实施策略基于科学服务实验室 (SSL)， 由 SAMHSA 资助的成瘾技术转移中心 (ATTC) 开发的方法，其中包括 相同的三个核心要素（即教学培训+绩效反馈+领导力辅导） 我们的疾病预防控制中心研究。根据 CDC 研究的反馈，对 SSL 策略进行了两项增强： 1) 将干预措施整合到电子病历中，作为提高 SBIRT 依从性的一种手段； 2) 为护士、社会工作者和组织领导者制定单独的培训课程以满足 每个群体的独特需求。此外，我们还围绕处方止痛药的使用提供咨询服务 缓解者将 SBIRT 干预作为探索性目标，因为大多数儿科创伤中心患者 出院后服用止痛药和有 AOD 使用史的患者滥用阿片类药物的风险较高。 利用阶梯式楔形设计，全国 10 个儿科创伤中心将获得 SSL 实施策略。本研究的数据收集依赖于多个来源。在六个不同的时间点， 10 个站点中的每个站点将提供来自 30 个 EMR 图表的数据（总共 1800 个图表）。青少年的一个子集 还将报告干预实施的保真度以及与护理的联系（即持续的 AOD 讨论和/或 出院后 1 个月接受初级保健提供者的治疗。此外，护士、社会工作者、 每个儿科创伤中心的领导者将报告组织实施的准备情况 三个不同的时间点。这项研究的结果将证明高度可扩展的实施策略， 根据我们的混合方法实施试验的结果，适用于儿科创伤中心，将改善 儿科创伤中心 SBIRT 实施的保真度（即一致性和质量）。

项目成果

Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers-a type III hybrid effectiveness-implementation trial.

在国家儿科创伤中心队列中实施酒精滥用 SBIRT——III 型混合有效性实施试验。

• 发表时间: 2018-02-22
• 作者: Mello, Michael J;Becker, Sara J;Bromberg, Julie;Baird, Janette;Zonfrillo, Mark R;Spirito, Anthony
• 通讯作者: Spirito, Anthony

Developing and Implementing Electronic Consent Procedures in Response to Covid-19 Restrictions.

制定和实施电子同意程序以应对 Covid-19 限制。

• 发表时间: 2022-07
• 作者: Bromberg, Julie R;Nimaja, Evelyn;Kiragu, Andrew W;Lawson, Karla A;Lee, Lois;Nasr, Isam W;Pruitt, Charles;Ruest, Stephanie M;Mello, Michael J
• 通讯作者: Mello, Michael J

Screening Adolescent Trauma Patients for Substance Use at 10 Pediatric Trauma Centers.

在 10 个儿科创伤中心筛查青少年创伤患者的药物使用情况。

• 发表时间: 2020
• 作者: Mello, Michael J;Becker, Sara J;Spirito, Anthony;Bromberg, Julie R;Wills, Hale;Barczyk, Amanda;Lee, Lois;Pruitt, Charles;Ebel, Beth E;Zonfrillo, Mark R;Nimaja, Evelyn;Scott, Kelli;Kiragu, Andrew;Nasr, Isam W;Aidlen, Jeremy T;Maxson, R Todd
• 通讯作者: Maxson, R Todd