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

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.

抽象的危险饮酒是一个严重的公共卫生问题，导致大量死亡率、发病率和医疗费用尽管这种情况在初级保健患者中很常见，但在美国，大约有 20% 的成人初级保健患者会出现这种情况。报告不健康的饮酒行为——在初级保健中很少得到解决，危险饮酒在那些有饮酒习惯的人中更为普遍。慢性疾病，如高血压、糖尿病和抑郁症，会影响疾病的进展和对于短期干预（BI）的有效性，人们知之甚少。作为主流初级保健的一部分提供的饮酒和健康结果。分析研究考察了正在进行的全系统酒精筛查、简短干预和转介的影响北加州 Kaiser Permanente 大型医疗保健服务系统中的治疗 (SBIRT) 计划于 2013 年使用 2014 年 1 月 1 日至 2014 年 1 月 1 日的电子健康记录 (EHR) 数据将 SBIRT 纳入其成人初级保健工作流程。 2019 年 6 月 30 日，约 479,070 名会员被确定为不健康饮酒者，其中约 191,628 人将进行过初级保健就诊并获得后续数据后，我们将检查接受 BI 对饮酒的影响风险饮酒筛查呈阳性的人群的结果、健康结果、成本和卫生服务利用率与那些没有收到 BI 的人进行比较，以了解 BI 如何、为谁以及在什么情况下发挥作用我们的研究解决了文献中的许多空白，包括对现实世界医疗保健的普遍性。筛查和 BI 作为常规医疗保健服务的一部分进行，数据收集作为护理的一部分的环境牧师的交付过程，超出了之前酒精筛查和简要随机对照试验中研究的人群我们将包括所有被确定为危险饮酒者的成年初级保健患者，无论其饮酒程度如何。严重程度，我们的大样本中的许多人患有慢性医疗和精神问题。让我们能够根据年龄、性别和种族来检查 BI 有效性的差异，这将提供关键信息解决弱势群体酒精问题检测和早期干预方面的差异。 EHR 中人口统计、临床合并症和服务使用数据的可用性使我们有机会检查我们使用创新模型来更全面地了解 BI 的动态及其对健康和服务的影响。 BI 和结果之间的关系，以及从中进行因果推断的新颖统计方法使用边际结构模型进行观察研究，并使用逆概率加权来解决选择偏差。我们的研究假设是减少过度饮酒、改善健康状况并减少不必要的饮酒如果得到证实，医疗保健成本和随着时间的推移使用可能会刺激酒精 SBIRT 在卫生系统和它被接受为初级保健机构的标准预防性卫生实践，这将对人们产生深远的影响。我们如何治疗和研究各种不健康的饮酒行为。