Tailored Screening, Brief Intervention, and Referral to Treatment for Medical Int

量身定制的筛查、简短的干预以及转诊至医疗机构的治疗

• 批准号: 9094247
• 负责人: Brendan James Clark
• 金额: $ 17.94万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9094247
• 关键词: Accounting; Acute; Address; Administrator; Admission activity; Adult Respiratory Distress Syndrome; Advisory Committees; Advocate; Alcohol consumption; Alcohols; American; Area; Benchmarking; Caring; Characteristics; Clinical; Clinical Investigator; Clinical Sciences; Clinical Trials; Colorado; Comorbidity; Coupled; Critical Care; Critical Illness; Data; Development; Educational Activities; Educational Curriculum; Effectiveness; Empirical Research; Ensure; Environment; Evidence based intervention; Extramural Activities; Family; Feedback; Focus Groups; Friends; Future; Goals; Guidelines; Health; Health Personnel; Health Services; Healthcare; Healthcare Systems; High Prevalence; Hospitals; Impaired cognition; Institutes; Intensive Care Units; Intervention; Interview; Knowledge; Lead; Learning; Left; Life; Literature; Mechanical ventilation; Medical; Medicine; Mentors; Methods; Morbidity - disease rate; National Institute on Alcohol Abuse and Alcoholism; Outcome; Patients; Positioning Attribute; Process; Provider; Psychiatry; Randomized Controlled Trials; Recommendation; Recovery; Research; Research Personnel; Risk Factors; Role; Sentinel; Small Business Innovation Research Grant; Structure; Survivors; System; Testing; Time; Training Programs; United States; Universities; Work; addiction; alcohol misuse; alcohol related consequences; alcohol related problem; alcohol research; alcohol use disorder; base; behavioral outcome; cost; design; drinking behavior; efficacy testing; experience; interdisciplinary approach; interest; loved ones; meetings; mortality; multidisciplinary; novel; patient population; programs; prospective; psychosocial; screening and brief intervention; screening, brief intervention, referral, and treatment; skills; theories; tool

DESCRIPTION (provided by applicant): Unhealthy alcohol use is present in up to 1.4 million survivors of critical illness in the U.S. each year. A severe acute illness requiring admission to medical intensive care unit (MICU) has been advocated as a "teachable moment" where appropriate interventions may lead to decreased morbidity related to alcohol. Although screening, brief intervention, and referral to treatment (SBIRT) has been extensively studied in the healthcare setting, prior studies do not address unique aspects of MICU survivors including a high prevalence of alcohol use disorders, reversible cognitive dysfunction, psychiatric co morbidities, and intimate involvement of family and loved ones in daily care and discharge planning. This proposal outlines a 5-year training program that will adapt and pilot SBIRT for MICU survivors and ultimately develop Dr. Brendan Clark into an independent academic clinical investigator. An integrated curriculum will build a tailored SBIRT system for MICU survivors and provide Dr. Clark with the necessary tools to be a leader in alcohol health services and critical care research. This program will consist of formal mentoring from four internationally renowned local experts in addition to coursework in clinical sciences and addiction. A multidisciplinary team will form an internal advisory committee to ensure that the goals and benchmarks of the proposal will be met. An external advisor whose expertise extends beyond that found at the University of Colorado Denver will provide feedback and input relevant to Dr. Clark's short and long-term goals. This structured curriculum will help Dr. Clark gain expertise in qualitative studies, learn how to design and conduct a randomized controlled trial, and develop knowledge in addiction psychiatry focusing on psychosocial aspects of addiction. The formal curriculum will coincide with practical experience gained through conducting the first prospective mixed methods study of MICU survivors with unhealthy alcohol use. Using a qualitative approach to engage important stakeholders including patients, friends/family, and healthcare providers/hospital systems, the proposed study will build on preliminary data to adapt SBIRT for MICU survivors. Because a high proportion of MICU survivors with unhealthy alcohol use have an AUD, this adapted SBIRT will focus on refining referral to treatment by developing a feasible role for a patient navigator. Subsequently, the feasibility and acceptability of this tailored SBIR system will be assessed in a pilot randomized controlled trial. The results of the proposed studies will tailor SBIRT for MICU survivors and leave Dr. Clark and the study team positioned to conduct a definitive multicenter clinical trial. An SBIRT system tailored to the needs of MICU survivors with unhealthy alcohol use would bridge the gap between treatment need and treatment utilization for a large population of patients at a time when they are uniquely motivated to change.

描述（由申请人提供）：在美国，每年有多达 140 万危重疾病幸存者存在不健康饮酒情况。需要入住医疗重症监护病房（MICU）的严重急性疾病被提倡为“教育时刻”，适当的干预措施可能会降低与酒精相关的发病率。尽管筛查、短暂干预和转诊治疗 (SBIRT) 已在医疗保健环境中进行了广泛研究，但先前的研究并未解决 MICU 幸存者的独特方面，包括酒精使用障碍、可逆性认知功能障碍、精神并发症和精神疾病的高患病率。家人和亲人密切参与日常护理和出院计划。该提案概述了一项为期 5 年的培训计划，该计划将为 MICU 幸存者调整和试点 SBIRT，并最终将 Brendan Clark 博士培养成为一名独立的学术临床研究者。 综合课程将为 MICU 幸存者构建量身定制的 SBIRT 系统，并为 Clark 博士提供成为酒精健康服务和重症监护研究领导者所需的工具。除了临床科学和成瘾方面的课程外，该计划还将包括四位国际知名当地专家的正式指导。多学科团队将组建一个内部咨询委员会，以确保提案的目标和基准得到满足。一名外部顾问的专业知识超出了科罗拉多大学丹佛分校的专业知识，他将提供与克拉克博士的短期和长期目标相关的反馈和意见。这种结构化课程将帮助克拉克博士获得定性研究方面的专业知识，学习如何设计和进行随机对照试验，并发展专注于成瘾心理社会方面的成瘾精神病学知识。 正式课程将与通过对不健康饮酒的 MICU 幸存者进行首次前瞻性混合方法研究所获得的实践经验相一致。拟议的研究将采用定性方法吸引重要利益相关者（包括患者、朋友/家人和医疗保健提供者/医院系统）的参与，以初步数据为基础，使 SBIRT 适应 MICU 幸存者。由于大部分患有不健康饮酒的 MICU 幸存者都有 AUD，因此经过调整的 SBIRT 将重点通过为患者导航员开发一个可行的角色来完善转诊治疗。随后，该定制 SBIR 系统的可行性和可接受性将在试点随机对照试验中进行评估。 拟议研究的结果将为 MICU 幸存者量身定制 SBIRT，并使 Clark 博士和研究团队能够进行最终的多中心临床试验。针对不健康饮酒的 MICU 幸存者的需求量身定制的 SBIRT 系统将在大量患者有独特动机时弥合治疗需求和治疗利用之间的差距 改变。