IAMSBIRT: Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers

IAMSBIRT：在国家儿科创伤中心队列中实施酒精滥用 SBIRT

基本信息

批准号：
10223170
负责人：
Michael J Mello
金额：
$ 62.85万
依托单位：
RHODE ISLAND HOSPITAL
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 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10223170
关键词：
Address Adolescent Adopted Adoption Alcohol or Other Drugs use American College of Surgeons Analgesics Caring Centers for Disease Control and Prevention (U.S.)Certification Clinical Computerized Medical Record Counseling Data Data Collection Development Drug Screening Drug usage Effectiveness Elements Feedback Funding Goals Health Personnel Hospitals Intervention Laboratories Leadership Mediating Methods Nurses Opioid Organizational Change Patients Pediatric cohort Performance Pharmaceutical Preparations Pharmacotherapy Provider Public Health Recording of previous events Reporting Research Risk Science Services Site Social Workers Source Technology Transfer Time Training Trauma patient Treatment Protocols United States Substance Abuse and Mental Health Services Administration addiction adolescent patient alcohol and other drug alcohol misuse alcohol screening alcohol screening and brief intervention base brief intervention care providers clinical care cohort design effectiveness evaluation effectiveness implementation study effectiveness implementation trial effectiveness testing evidence base implementation research implementation science implementation strategy implementation study implementation trial improved injured opioid misuse organizational readiness pain patient patient oriented pediatric trauma prescription pain reliever public health relevance screening screening, brief intervention, referral, and treatment social organization trauma centers treatment adherence

项目摘要

PROJECT SUMMARY In 2006, the American College of Surgeons (ACS) adopted a requirement for certification as a level one trauma center that mandated universal screening for alcohol misuse and delivery of a brief intervention for those screening positive. Though this requirement has been mandated for a decade, its implementation has been challenging, especially for pediatric trauma centers. Our research team completed a CDC funded implementation study supporting seven pediatric trauma centers' compliance with the ACS requirement by developing and implementing an institutional alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol for adolescent trauma patients. A mixed-methods approach indicated that SBIRT adoption rates increased at all sites; however, providers' fidelity to the SBIRT intervention was variable, and providers reported a number of barriers to SBIRT implementation. The goal of this application is to conduct a fully powered Type III hybrid effectiveness-implementation trial to test the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug use in pediatric trauma centers. Our implementation strategy is based on the Science to Service Laboratory (SSL), an approach developed by the SAMHSA-funded Addiction Technology Transfer Centers (ATTCs) that consists of the same three core elements (i.e., didactic training + performance feedback + leadership coaching) used in our CDC study. Based on feedback from the CDC study, two enhancements were made to the SSL strategy: 1) integration of the intervention into the electronic medical record as a means of improving SBIRT adherence; and 2) development of separate training tracks for nurses, social workers and organizational leaders to meet the unique needs of each group. In addition, we integrate counseling around the use of prescription pain relievers into the SBIRT intervention as an Exploratory Aim, since most pediatric trauma center patients are discharged on pain medication and patients with a history of AOD use are at elevated risk of opioid misuse. Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers will receive the SSL implementation strategy. Data collection for this study relies on multiple sources. At six distinct time points, each of the 10 sites will provide data from 30 EMR charts (n = 1800 charts in total). A subset of adolescents will also report on fidelity of intervention delivery and linkage to care (i.e., continued AOD discussion and/or treatment with a primary care provider) 1 month post hospital discharge. In addition, nurses, social workers, and leaders from each pediatric trauma center will report on organizational readiness for implementation at three distinct time points. Results of this study will demonstrate that a highly scalable implementation strategy, adapted for pediatric trauma centers from the results of our mixed-methods implementation trial, will improve the fidelity (i.e., the consistency and quality) of SBIRT delivery in pediatric trauma centers.