Population-based Screening and Brief Intervention in Primary Care: Health and Drinking Outcomes, Cost and Utilization

初级保健中基于人群的筛查和短期干预：健康和饮酒结果、成本和利用

基本信息

批准号：
9355066
负责人：
Stacy Ann Sterling
金额：
$ 40.06万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-01 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9355066
关键词：
Accident and Emergency department Address Adoption Adult Affect Age Alcohol abuse Alcohol consumption Alcohol or Other Drugs use Alcohols Attention Behavior Therapy California Caring Cessation of life Chronic Chronic Disease Clinical Clinical Trials Comorbidity Consumption Control Groups Data Detection Diabetes Mellitus Disease Disease Outcome Disease Progression Early Intervention Effectiveness Effectiveness of Interventions Electronic Health Record Ethnic Origin Gender Health Health Care Costs Health Services Health system Healthcare Healthcare Systems Hyperlipidemia Hypertension Individual Inpatients Intervention Studies Literature Mainstreaming Medical Mental Depression Modeling Morbidity - disease rate Observational Study Outcome Pathway interactions Patient Care Patient Self-Report Patients Population Population Study Prevalence Preventive Primary Health Care Probability Process Public Health Randomized Clinical Trials Recovery Reporting Research Sampling Selection Bias Self Management Services Severities Severity of illness Statistical Methods Structural Models System Techniques Time Treatment Efficacy Treatment outcome Visit Vulnerable Populations Weight Work alcohol abuse therapy alcohol misuse alcohol screening alcohol screening and brief intervention alcohol use disorder brief alcohol intervention brief intervention care delivery cohort cost cost effectiveness drinking ethnic diversity follow-up health care delivery health care service utilization health practice health service use high risk drinking improved indexing innovation medical specialties medication compliance member mortality novel population based primary care setting public health relevance racial diversity screening screening and brief intervention screening, brief intervention, referral, and treatment secondary analysis treatment as usual

Accident and Emergency department Address Adoption Adult Affect Age Alcohol abuse Alcohol consumption Alcohol or Other Drugs use Alcohols Attention Behavior Therapy California Caring Cessation of life Chronic Chronic Disease Clinical Clinical Trials Comorbidity Consumption Control Groups Data Detection Diabetes Mellitus Disease Disease Outcome Disease Progression Early Intervention Effectiveness Effectiveness of Interventions Electronic Health Record Ethnic Origin Gender Health Health Care Costs Health Services Health system Healthcare Healthcare Systems Hyperlipidemia Hypertension Individual Inpatients Intervention Studies Literature Mainstreaming Medical Mental Depression Modeling Morbidity - disease rate Observational Study Outcome Pathway interactions Patient Care Patient Self-Report Patients Population Population Study Prevalence Preventive Primary Health Care Probability Process Public Health Randomized Clinical Trials Recovery Reporting Research Sampling Selection Bias Self Management Services Severities Severity of illness Statistical Methods Structural Models System Techniques Time Treatment Efficacy Treatment outcome Visit Vulnerable Populations Weight Work alcohol abuse therapy alcohol misuse alcohol screening alcohol screening and brief intervention alcohol use disorder brief alcohol intervention brief intervention care delivery cohort cost cost effectiveness drinking ethnic diversity follow-up health care delivery health care service utilization health practice health service use high risk drinking improved indexing innovation medical specialties medication compliance member mortality novel population based primary care setting public health relevance racial diversity screening screening and brief intervention screening, brief intervention, referral, and treatment secondary analysis treatment as usual

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项目摘要

ABSTRACT Risky alcohol use is a serious public health problem contributing to significant mortality, morbidity and healthcare costs each year. Although it is common among primary care patients – around 20% of adult primary care patients in the U.S. report unhealthy alcohol use – it is rarely addressed in primary care. Risky use is even more prevalent among those with chronic medical conditions such as hypertension, diabetes, and depression, and can affect disease progression and severity, self-management and treatment outcomes. Little is known about the effectiveness of brief intervention (BI) on drinking and health outcomes when delivered as part of mainstream primary care. This population-based, secondary analysis study examines the impact of an ongoing system-wide alcohol screening, brief intervention and referral to treatment (SBIRT) initiative in a large health care delivery system, Kaiser Permanente Northern California, which in 2013 incorporated SBIRT into its adult primary care workflow. Using electronic health record (EHR) data from 1/1/2014 to 06/30/2019 for the approximately ~479,070 members identified as unhealthy drinkers, about 191,628 of whom will have had return primary care visits and thus follow-up data, we will examine the effects of receiving a BI on the drinking outcomes, health outcomes, and costs and health services utilization among those screening positive for risky drinking compared to those not receiving a BI, in order to understand how, for whom and under what circumstances BIs work for risky drinkers. Our study addresses many of the gaps in the literature, including generalizability to real-world healthcare settings where screening and BI occurs as part of routine healthcare delivery and data is collected as part of the care delivery process by clinicians, going beyond the populations studied in previous RCTs of alcohol screening and brief intervention. We will include all adult primary care patients identified as risky drinkers, with all levels of drinking severity, many of who have chronic medical and psychiatric problems. Our large sample’s ethnic and racial diversity will allow us to examine differences in BI effectiveness by age, gender, and ethnicity, which will provide critical information for addressing disparities in the detection and early intervention of alcohol problems in vulnerable populations. The availability of demographic, clinical comorbidity and services use data in the EHR provides us the opportunity to examine the dynamics of BI and its impact on health and services more holistically. We use an innovative model to conceptualize the relationships between BIs and outcomes, and novel statistical methods to make causal inference from this observational study using marginal structural models, and we address selection bias using inverse probability weighting. Our research hypotheses of reduced excessive alcohol use, improvement in health outcomes and decreases in unnecessary healthcare costs and utilization over time, if confirmed, could spur wider adoption of alcohol SBIRT in health systems and its acceptance as a standard preventive health practice in primary care settings. This would have a profound impact on how we treat and study the full spectrum of unhealthy alcohol use.

抽象的危险的饮酒是严重的公共卫生问题，导致了重大死亡率，发病率和医疗保健费用每年。尽管在初级保健患者中很常见 - 大约有20％的美国成人初级保健患者报告不健康的饮酒 - 在初级保健中很少解决。在患有风险的人中，有风险的使用更加普遍高血压，糖尿病和抑郁等慢性病，可能会影响疾病的进展和严重性，自我管理和治疗结果。关于简短干预（BI）对的有效性知之甚少作为主流初级保健的一部分，饮酒和健康结果。这个基于人群的次要分析研究检查了正在进行的全系统筛查，简短干预和转诊至大型医疗保健提供系统的治疗（SBIRT）倡议，Kaiser Permanente North California，该计划于2013年将SBIRT纳入其成人初级保健工作流程中。使用从2014年1月1日到的电子健康记录（EHR）数据 2019年6月30日，大约〜479,070名成员被确定为不健康的饮酒者，其中约有191,628名经过返回初级保健访问，因此随访数据，我们将研究接受BI对饮酒的影响结果，健康成果以及成本和健康服务的利用率，筛查有危险的饮酒阳性的人与未收到BI的人相比，以了解如何，在哪种情况下为哪些情况和在什么情况下工作有冒险的饮酒者。我们的研究解决了文献中的许多差距，包括对现实世界医疗保健的普遍性作为常规医疗保健提供和数据的一部分进行筛查和BI的设置，作为护理的一部分临床医生的交付过程，超出了以前的酒精筛查和简短的RCT中所研究的人群干涉。我们将包括所有被确定为风险饮用者的成年初级保健患者严重程度，许多患有慢性医学和精神病问题的人。我们大型样本的种族和种族多样性将允许我们检查按年龄，性别和种族划分的双重效率差异，这将提供关键信息解决脆弱人群中酒精问题的检测和早期干预方面的差异。这人口统计学，临床合并症和服务的可用性在EHR中使用数据为我们提供了检查的机会 BI的动力及其对健康和服务的影响更全面。我们使用创新模型来概念化 BIS与结果之间的关系，以及从中提出因果推断的新型统计方法使用边际结构模型的观察性研究，我们使用反概率加权解决选择偏差。我们的研究假设是减少饮酒，健康结果的改善和不必要的下降的假设随着时间的流逝，医疗保健成本和利用情况，如果确认，可以刺激更广泛的酒精饮料在卫生系统和在初级保健环境中，它是一种标准的预防健康实践。这将对我们如何治疗和研究不健康的饮酒。