Validating NIAAA's brief screening guide in youth with chronic medical conditions

验证 NIAAA 针对患有慢性疾病的青少年的简要筛查指南

基本信息

批准号：
8427531
负责人：
SHARON J LEVY
金额：
$ 39.15万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-20 至 2015-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8427531
关键词：
16 year old 18 year old Accounting Address Adolescent Age Alcohol abuse Alcohol consumption Alcohol dependence Alcohol or Other Drugs use Alcohols Algorithms Asthma Blood Glucose Blood Glucose Self-Monitoring Boston Boxing Budgets Caring Categories Childhood Chronic Chronic Disease Classification Clinic Clinical Complex Confidence Intervals Consent Consumption Dependence Diabetes Mellitus Diagnosis Diagnostic Disease Disease Management Disease Outcome Dose Early identification Electronics Environment Equation Equilibrium Food Frequencies Friends Goals Gold Health Health Care Costs Health Status Healthcare Home environment Instruction Insulin Intervention Interview Investments Logic Logistic Regressions Measures Medical Methods Modification Morbidity - disease rate National Institute on Alcohol Abuse and Alcoholism Outcome Participant Patients Pediatric Hospitals Pharmaceutical Preparations Physicians Play Population Population Study Predictive Value Process Property Prospective Studies Quality of life Recommendation Regression Analysis Relative Risks Reporting Risk Risk Factors Role Sampling Screening Result Screening procedure Self Care Sensitivity and Specificity Social Workers Specific qualifier value Structure Students Testing Treatment Protocols Triage Ulcerative Colitis Validation Visit Youth adolescent alcohol alcohol risk alcohol screening alcohol use disorder base behavioral health brief alcohol screening brief screening burden of illness cohort compliance behavior cost depressive symptoms design drinking falls follow-up global health high risk high school improved medical specialist medical specialties medication compliance meetings neglect novel strategies peer response social standard measure tool treatment adherence

项目摘要

DESCRIPTION (provided by applicant): Our goal is to validate the NIAAA Guide with youth with chronic medical conditions (YCMC) to facilitate standardized screening and improve the response capability of physicians who regularly interact with them. YCMC are a large and expensive population uniquely vulnerable to harm from drinking given the potential for alcohol to negatively interact with both their underlying health condition and its treatment. We take a novel approach, collecting a battery of assessment information from 400 assented/consented youth (ages 9-18 years) being treated at Children's Hospital Boston for one of four target conditions (asthma, diabetes, a rheumatic disorder or ulcerative colitis; 100 each). Participants will complete an electronic version of the NIAAA guide and an assessment battery comprised of a structured diagnostic interview for alcohol use disorders, a measure of frequency/quantity of alcohol use; a brief interview about friends' use of alcohol and additional brief structured report about medication adherence, quality of life and depressive symptoms. Information on chronic disease status and alcohol risk factors will be obtained via chart review, with input from a team of clinical collaborators with domain expertise in target conditions. Specific Aims are to: Aim 1) validate an NIAAA-Guide based screening algorithm against gold standard measures of alcohol use disorders in the study population, testing the hypothesis that the Guide will yield sensitivity and specificity > .75 for correctly identifying the group of YCMC who have problematic use/ abuse or alcohol dependence. We will use the bootstrap method of re-sampling to estimate 95% confidence intervals about each measure of sensitivity, specificity, and positive and negative predictive values; Aim 2) Evaluate associations between alcohol risk categories established by the NIAAA Guide and measures of other substance use, chronic disease and overall health status and disease management testing hypotheses that (i) Youth with alcohol use problems or disorders will be more likely to use other substances, and will score significantly lower on measures of global health, treatment adherence and chronic disease status, and (ii) consideration of chronic disease- related alcohol risks expands the proportion of youth who fall within the problem use range. We will use Generalized Estimating Equations logistic regression analysis to identify significant differences among those with problem use, abuse and dependence vs. those without on scale scores and other continuous measures of global health and markers of chronic disease status, controlling for moderators and the complex sample design in which participants are nested within clinics and; Aim 3) Develop recommendations for clinician guidance and health messages for inclusion in the Guide for use with YCMC, generated in a modified Delphi process with 20 clinician experts and field tested with patients. Deliverables are a validated, electronic screening tool that triages YCMC into actionable risk groups, contains guidance and examples of field-tested, salient, alcohol related advice, and baseline measures and an initial cohort for a continued prospective study.

描述（由申请人提供）：我们的目标是针对慢性病青少年 (YCMC) 验证 NIAAA 指南，以促进标准化筛查并提高定期与他们互动的医生的反应能力。 YCMC 人口众多且消费昂贵，特别容易受到饮酒伤害，因为酒精可能会对他们的基本健康状况及其治疗产生负面影响。我们采用一种新颖的方法，收集了 400 名在波士顿儿童医院接受治疗的青少年（9-18 岁）的一系列评估信息，这些青少年患有四种目标病症（哮喘、糖尿病、风湿性疾病或溃疡性结肠炎；100每个）。参与者将完成 NIAAA 指南的电子版和评估套件，其中包括酒精使用障碍的结构化诊断访谈、酒精使用频率/数量的衡量标准；关于朋友饮酒情况的简短采访以及关于药物依从性、生活质量和抑郁症状的附加简短结构化报告。有关慢性病状况和酒精危险因素的信息将通过图表审查获得，并由具有目标条件领域专业知识的临床合作者团队提供输入。具体目标是：目标 1) 根据研究人群中酒精使用障碍的金标准测量来验证基于 NIAAA 指南的筛查算法，测试该指南将产生 > 0.75 的敏感性和特异性以正确识别 YCMC 组的假设有使用/滥用或酒精依赖问题的人。我们将使用重新抽样的 bootstrap 方法来估计每个灵敏度、特异性以及阳性和阴性预测值测量的 95% 置信区间；目标 2) 评估《NIAAA 指南》建立的酒精风险类别与其他物质使用、慢性疾病和整体健康状况的衡量标准以及疾病管理测试假设之间的关联：(i) 有酒精使用问题或障碍的青少年更有可能使用其他药物的物质，并且在全球健康、治疗依从性和慢性病状况的衡量标准上得分显着较低，并且（ii）考虑与慢性病相关的酒精风险会扩大属于问题使用范围内的青少年比例。我们将使用广义估计方程逻辑回归分析来识别那些有问题使用、滥用和依赖的人与那些没有量表分数和其他全球健康和慢性病状态标志的连续测量的人之间的显着差异，控制调节器和复杂样本参与者嵌套在诊所内的设计；目标 3) 制定临床医生指导和健康信息建议，纳入 YCMC 使用指南，由 20 名临床医生专家在修改后的 Delphi 流程中生成，并与患者进行现场测试。可交付成果是一种经过验证的电子筛查工具，可将 YCMC 分类为可操作的风险组，包含经过现场测试的、突出的、与酒精相关的建议的指导和示例、基线措施以及用于持续前瞻性研究的初始队列。