Understanding practical alcohol measures in primary care to prepare for measurement-based care: Scaled EHR measures of alcohol use and DSM-5 AUD symptoms

了解初级保健中的实用酒精测量方法，为基于测量的护理做好准备：酒精使用和 DSM-5 AUD 症状的按比例 EHR 测量

• 批准号: 10688183
• 负责人: Kevin A Hallgren
• 金额: $ 37.54万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10688183
• 关键词: Accounting; Address; Adult; Affect; Age; Alcohol abuse; Alcohol consumption; Alcohols; Appointment; Awareness; Blood Pressure; Caring; Clinical; Cross-Sectional Studies; DSM-V; Data; Data Set; Development; Diagnosis; Electronic Health Record; Ethnic Origin; Ethnic Population; Evaluation; Foundations; Frequencies; Future; Health; Health Services; Health system; Healthcare Systems; Hospitalization; Measurement; Measures; Medical; Methodology; Monitor; National Institute on Alcohol Abuse and Alcoholism; Outcome; Outcome Measure; Patient Outcomes Assessments; Patients; Performance; Persons; Phase; Physiological; Positioning Attribute; Prevalence; Primary Care; Provider; Psychometrics; Public Health; Race; Readiness; Reporting; Research; Research Personnel; Risk; Sample Size; Sampling; Severities; Standardization; Subgroup; Symptoms; Testing; Time; Washington; Woman; Work; alcohol measurement; alcohol misuse; alcohol screening; alcohol use disorder; behavioral health; care systems; clinical care; clinical practice; depressive symptoms; disability; drinking; epidemiology study; implementation study; implementation trial; improved; longitudinal analysis; male; mortality; novel; pragmatic study; pragmatic trial; primary care patient; primary care setting; racial population; research study; response; routine care; routine screening; sex; standardize measure; young adult

Project Summary. Primary care (PC) is well-positioned to detect and address unhealthy drinking and alcohol use disorder (AUD), yet most PC settings have notable gaps in providing alcohol-related care. One way to improve alcohol-related care is to use standardized measurements to screen for unhealthy alcohol use and to assess AUD symptoms, which informs clinical care by detecting unhealthy drinking, assessing AUD severity, informing decisions about AUD treatment intensity, and monitoring clinical outcomes over time. Researchers and national agencies are increasingly calling for the use of standardized measures of unhealthy drinking and AUD symptoms in routine PC settings; however, surprisingly little is known about how such measures perform or what they indicate about health risks when they are used in the context of routine PC—i.e., administered in routine appointments and documented in electronic health records (EHRs). We propose to leverage a large and novel EHR dataset from Kaiser Permanente Washington, a large integrated regional health system. The dataset will include: the AUDIT-C alcohol screening measure, completed as part of an annual screen by >250,000 patients (89% of adults who attend PC appointments); a novel patient-reported AUD symptom checklist that is based on the 11 DSM-5 AUD criteria (“DSM-5 checklist”), completed by over 4,000 patients (>70% of those with AUDIT-C scores ≥ 7); and diverse health outcome measures available from EHR, administrative, and claims data. The 2-year developmental R21 phase includes psychometric analyses that evaluate the DSM-5 checklist as a scaled measure of AUD severity and the consistency of its performance across demographically diverse subgroups; to our awareness, this is the first study to evaluate any standardized patient-reported AUD symptom measure integrated into routine PC. Cross-sectional analyses will examine associations between the AUDIT-C, DSM-5 checklist, and important health outcome measures known to be associated with drinking, including systolic blood pressure, patient-reported depression symptoms, hospitalizations for alcohol-attributable conditions, all-cause hospitalizations, and all-cause mortality. The R21 will also achieve milestones demonstrating readiness for the R33 phase. During the 3-year R33 phase, longitudinal analyses will test whether the AUDIT-C and DSM-5 checklist are associated with subsequent health outcomes and whether within-person changes in AUDIT-C scores over time are associated with changes in health outcomes. To our awareness, this work will be the first to evaluate a patient-reported AUD symptom checklist in any routine PC setting and the first to evaluate the AUDIT-C in any non-veteran routine PC setting. This research will improve clinical care by helping providers and patients understand the information provided by these scaled patient-reported measures and their associations with important adverse health outcomes. The work will also provide a foundation for future studies that use patient-reported EHR- based measures in pragmatic studies, implementation trials, and quality improvement initiatives.

项目摘要。初级保健（PC）的位置良好，可以检测和解决不健康的饮酒和酒精 使用障碍（AUD），但是大多数PC设置在提供与酒精有关的护理方面都有明显的差距。一种方法 改善与酒精相关的护理是使用标准化的测量结果来筛选不健康的酒精使用和 评估AUD症状，该症状通过检测不健康的饮酒，评估AUD严重程度来告知临床护理， 告知有关AUD治疗强度的决定，并随着时间的推移监测临床结果。研究人员 国家机构越来越多地呼吁使用不健康的饮酒和 常规PC设置中的AUD症状；但是，对于此类措施的执行方式鲜为人知 或者他们指出的关于健康风险在常规PC的背景下使用时的健康风险（即 日常任命并记录在电子健康记录（EHRS）中。我们建议利用大型 以及来自Kaiser Permanente Washington的新型EHR数据集，这是一个大型综合区域卫生系统。这 数据集将包括：审核-C酒精筛查测量，作为年度屏幕的一部分完成 > 25万​​名患者（参加PC任命的成年人中有89％）；一种新颖的患者报告的AUD症状 基于11个DSM-5 AUD标准（“ DSM-5清单”）的清单，由4,000多名患者完成 （> 70％的审核-C分数≥7）； EHR提供的潜水健康结果指标， 行政和索赔数据。 2年的R21阶段包括心理测量分析 评估DSM-5清单作为AUD严重性的缩放度量及其性能的一致性 跨人口统计多样化的亚组；为了我们的意识，这是第一个评估任何评估的研究 标准化患者报告的AUD症状测量结果集成到常规PC中。横断面分析将 检查审核-C，DSM-5清单和重要的健康结果指标之间的关联 与饮酒有关，包括收缩压，患者报告的抑郁症状， 酒精饮料病情，全因住院和全因死亡率的住院治疗。 R21 还将实现对R33阶段准备就绪的里程碑。在3年R33阶段， 纵向分析将测试审计-C和DSM-5清单是否与后续 健康结果以及随着时间的推移审核-C分数的人身内部变化是否与 健康结果的变化。为了我们的意识，这项工作将是第一个评估患者报告的AUD的工作 任何常规PC设置中的症状清单，也是第一个评估任何非退伍军人常规的审计-C PC设置。这项研究将通过帮助提供者和患者了解 这些缩放的患者报告措施及其与重要逆境的关联提供的信息 健康结果。这项工作还将为未来的研究提供基础，该研究使用患者报告的EHR- 基于务实研究，实施试验和质量改进计划的措施。