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）：每年美国最多可容纳140万个危害疾病幸存者的饮酒。在适当的干预措施可能导致与酒精有关的发病率下降的情况下，已提倡需要接受医疗重症监护病房（MICU）的严重急性疾病。尽管在医疗保健环境中进行了广泛的研究，尽管筛查，简短的干预和转诊（SBIRT）已进行了广泛的研究，但先前的研究并未解决MICU幸存者的独特方面，包括饮酒障碍的高流行，可逆的认知功能障碍，精神病学共识，精神上的病假和亲密的家人和所爱人的日常生活和待遇。该提案概述了一项为期5年的培训计划，该计划将适应MICU幸存者的适应和驾驶SBIRT，并最终将Brendan Clark博士发展成为一个独立的学术临床研究者。 综合课程将为MICU幸存者建立量身定制的SBIRT系统，并为Clark博士提供必要的工具，成为酒精卫生服务和重症监护研究的领导者。该计划将包括来自四位国际知名本地专家的正式指导，除了临床科学和成瘾课程。多学科团队将组成一个内部咨询委员会，以确保将实现该提案的目标和基准。一位外部顾问的专业知识超出了科罗拉多大学丹佛大学的专业知识，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。该结构化的课程将帮助克拉克博士在定性研究中获得专业知识，学习如何设计和进行随机对照试验，并在成瘾精神病学方面发展知识，重点是成瘾的心理社会方面。 正式的课程将与通过不健康的饮酒对MICU幸存者进行首次前瞻性混合方法研究获得的实际经验一致。使用定性方法来吸引重要的利益相关者，包括患者，朋友/家人和医疗保健提供者/医院系统，拟议的研究将基于初步数据，以适应MICU幸存者的SBIRT。由于使用不健康饮酒的MICU幸存者比例很高，因此这种适应的SBIRT将专注于通过为患者导航员开发可行的作用来提炼对治疗。随后，该量身定制的SBIR系统的可行性和可接受性将在试验随机对照试验中进行评估。 拟议的研究的结果将为MICU幸存者量身定制SBIRT，并离开Clark博士，研究团队定位进行确定的多中心临床试验。满足不健康饮酒的MICU幸存者需求的SBIRT系统将弥合大量患者的治疗需求和治疗利用之间的差距 改变。