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

• 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
• 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

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.

项目摘要 2006年，美国外科医生学院（ACS）采用了认证的要求，作为一级创伤 为滥用酒精的普遍筛查的中心 筛选阳性。尽管这项要求已被授权十年，但其实施已有 具有挑战性，尤其是针对小儿创伤中心。我们的研究团队完成了疾病预防控制中心资助的 实施研究支持七个小儿创伤中心遵守ACS要求 开发和实施机构酒精筛查，简短的干预和转介治疗 （SBIRT）青少年创伤患者方案。混合方法的方法表明采用了SBIRT 所有地点的费率都在增加；但是，提供者对SBIRT干预的保真度是可变的，提供者 报告了SBIRT实施的许多障碍。该应用的目的是完全进行 动力III型混合有效性实施试验，以测试全面的有效性 实施策略，以增加对酒精和其他药物使用的SBIRT实施 创伤中心。我们的实施策略基于服务实验室科学（SSL），这是一个 由SAMHSA资助的成瘾技术转移中心（ATTC）开发的方法 使用的三个核心要素（即教学培训 +绩效反馈 +领导力教练） 我们的CDC研究。根据CDC研究的反馈，对SSL策略进行了两个增强： 1）将干预措施整合到电子病历中，以改善SBIRT依从性； 2）为护士，社会工作者和组织领导者开发单独的培训轨道 每个组的独特需求。此外，我们将咨询围绕使用处方疼痛进行整合 作为探索性目的，救助者进入SBIRT干预措施，因为大多数儿科创伤中心患者是 在止痛药中出院和使用AOD史的患者的阿片类药物滥用风险较高。 利用台阶楔形设计，由10个儿科创伤中心组成的国家队列将获得SSL 实施策略。这项研究的数据收集依赖于多种来源。在六个不同的时间点， 这10个站点中的每个站点都将提供来自30个EMR图表的数据（总共n = 1800个图表）。青少年的子集 还将报告有关干预交付和与护理联系的忠诚度（即，持续的AOD讨论和/或 出院后1个月，由初级保健提供者进行治疗。此外，护士，社会工作者， 每个儿科创伤中心的领导人将报告组织准备就绪 三个不同的时间点。这项研究的结果将表明一种高度可扩展的实施策略， 根据我们的混合方法实施试验的结果，适用于儿科创伤中心，将改善 小儿创伤中心的Sbirt递送的保真度（即一致性和质量）。