K23 Novel Interventions for Alcohol Dependent Frequent ED Users

K23 针对酒精依赖频繁 ED 用户的新颖干预措施

基本信息

批准号：
9127717
负责人：
Ryan P McCormack
金额：
$ 18.54万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-10 至 2019-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9127717
关键词：
Accident and Emergency department Accounting Acute Address Alcohol consumption Alcohol dependence Alcohols Algorithms Ambulances Ambulatory Care Behavior Therapy Board Certification Caring Case Management Cessation of life Chronic Clinical Collaborations Community Hospitals Comorbidity Complex Controlled Clinical Trials Data Discipline Effectiveness Emergency Department patient Emergency Medicine Emergency Situation Emergency department visit Enrollment Evaluation Feasibility Studies Future Group Meetings Health Health Care Costs Health Care Visit Health Services Health system Healthcare Heavy Drinking High Prevalence Home environment Homelessness Hospital Departments Housing Individual Inpatients Institution Intake Internal Medicine Intervention Intervention Trial Intoxication Measures Medical Medicine Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Mission Modeling Naltrexone National Institute on Alcohol Abuse and Alcoholism Nature Outcome Outpatients Participant Patient Outcomes Assessments Patients Persons Pharmaceutical Preparations Pharmacological Treatment Pharmacotherapy Physicians Policies Population Positioning Attribute Preparation Prevalence Process Psychiatry Psychosocial Influences Public Health Randomized Recruitment Activity Reporting Research Research Design Research Infrastructure Research Personnel Research Training Resources Services Social Health Services Social Work Societies Structure System Target Populations Testing Training Training Programs Vision Vulnerable Populations Work addiction administrative database alcohol abuse therapy alcohol use disorder apprenticeship base care seeking career career development cost design drinking effective intervention effectiveness trial experience flexibility follow-up health care delivery health care quality health care service utilization health service use implementation trial improved information gathering innovation intervention effect mortality multi-component intervention multidisciplinary novel patient oriented patient population population health psychosocial public health relevance research study response screening social standard care success supported housing symposium

项目摘要

DESCRIPTION (provided by applicant): The PI, Ryan McCormack, MD, is an emergency medicine physician whose broad clinical background and research experience, including board certification in Emergency, Internal, and Addiction Medicine, reflects his commitment to integrating health services using collaborative, patient-oriented approaches to enhance healthcare quality for individuals with alcohol use disorders (AUDs). His preliminary research has focused on alcohol dependent frequent emergency department (ED) users, a vulnerable population that has a disproportionate impact on healthcare and societal costs. These individuals are difficult to engage in their personal health and often receive care exclusively in EDs, rather than settings offering treatment for addiction and other chronic conditions. Despite its prevalence, treatment for AUDs is rarely initiated in the ED, and research to develop and implement effective interventions is even less common. Dr. McCormack adapted a validated algorithm to identify this target population and developed and tested a multidisciplinary, care management (CM) intervention that coordinates health and social services using existing resources through collaboration with public health agencies. He demonstrated feasibility and promising outcomes, including housing placement and reduced ED and inpatient use and mortality compared to controls. His proposed research will incorporate efficacious pharmacotherapy in the form of extended-release naltrexone (XR-NTX) to this intervention. Fifty participants will be randomized to receive XR-NTX+CM or standard care, which will be initiated in the ED and continued through coordination of care across departments and partnering agencies. He will assess feasibility and acceptability of implementing this intervention and of rigorously testing its 6- and 12- month effect on healthcare utilization and heavy drinking. Information gathered on its delivery as well as process evaluations and refinements will inform subsequent effectiveness-implementation trials. This K23 award will support Dr. McCormack in advanced research training and mentoring, allowing him to conduct his proposed research, which will form the basis for an R01 application on studies that integrate alcohol treatment in diverse clinical settings. His career development also includes structured mentorship and apprenticeships, comprehensive didactic training, as well as participation in academic conferences, research group meetings and studies, and reporting findings. Through his partnership with several public health agencies, the infrastructure of NYU, and his team of experienced and accomplished mentors that span emergency and internal medicine, psychiatry, population health, Dr. McCormack is well-positioned to become an independent investigator committed to developing and testing models of intervention and disseminating innovative practices and policies across health systems. The trans-disciplinary, collaborative nature of his work and his aim "to improve the effectiveness, efficiency and equity of services designed to reduce the public health burden of AUDs" are well aligned with the Mission and Vision of NIAAA.

描述（由申请人提供）：PI，Ryan McCormack，医学博士是一名急诊医学医师，其广泛的临床背景和研究经验，包括急诊，内部和成瘾医学的董事会认证，反映了他对使用协作，以患者为方便的方法来整合卫生服务的承诺，以增强酒精使用调情患者的医疗质量（AUDES）。他的初步研究集中在依赖酒精的急诊室（ED）用户上，这是一个脆弱的人群，对医疗保健和社会成本的影响不成比例。这些人很难从事个人健康，并且经常在ED中获得护理，而不是为成瘾和其他慢性病提供治疗。尽管它的盛行率很高，但在ED中很少开始使用AUD的治疗，而开发和实施有效干预措施的研究甚至不太常见。 McCormack博士改编了经过验证的算法，以识别该目标人群，并开发和测试了多学科的护理管理（CM）干预措施，该干预措施通过与公共卫生机构的合作使用现有资源来协调健康和社会服务。与对照组相比，他证明了可行性和有希望的结果，包括住房位置以及减少的ED和住院使用和死亡率。他提出的研究将以扩展释放的纳曲酮（XR-NTX）的形式融合有效的药物治疗，以进行此干预措施。五十名参与者将被随机接收XR-NTX+CM或标准护理，这些参与者将在ED中启动，并通过各部门和合作机构的护理进行协调。他将评估实施这种干预措施的可行性和可接受性，并严格测试其6个月和12个月对医疗保健利用和大量饮酒的影响。收集的有关其交付以及过程评估和改进的信息将为随后的有效性试验提供信息。该K23奖将支持McCormack博士在高级研究培训和指导中，使他能够进行拟议的研究，这将构成R01在不同临床环境中整合酒精治疗的研究的基础。他的职业发展还包括结构化指导和学徒制，全面的教学培训，以及参加学术会议，研究小组会议和研究以及报告结果。通过与几个公共卫生机构，纽约大学的基础设施以及他的经验丰富和有成就的导师团队的合作关系，麦考马克博士凭借良好的态度，成为一个独立的研究人员，致力于开发和测试干预和测试跨健康系统的独立研究人员。他的工作的跨学科，协作性质和他的目标“旨在提高旨在减轻AUDS公共健康负担的服务的有效性，效率和公平性”与NIAAA的使命和愿景非常吻合。