Development and Testing of an Integrated Care Coordination Intervention for Alcohol Use Disorder Recovery after Liver Transplantation

肝移植后酒精使用障碍康复综合护理协调干预措施的开发和测试

• 批准号: 10723316
• 负责人: Leigh Anne Dageforde
• 金额: $ 19.76万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10723316
• 关键词: Acute; Address; Advocacy; Affect; Alcohol consumption; Alcoholic Hepatitis; Alcoholic Liver Diseases; Alcohols; Caring; Cause of Death; Chronic; Chronic Care; Cirrhosis; Clinic; Clinic Visits; Clinical; Communities; Community Health Aides; Complement; Complex; Comprehensive Health Care; Consolidated Framework for Implementation Research; Data Collection; Development; Disease remission; Effectiveness; Environment; Equity; Failure; Feasibility Studies; Feedback; Female; Fostering; Funding; Future; Goals; Health; Health education; Heavy Drinking; Hispanic; Hybrids; Immunosuppression; Improve Access; Intervention; Interview; K-Series Research Career Programs; Knowledge; Life; Managed Care; Manuscripts; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modeling; Organ Transplantation; Outcome; Participant; Pathway interactions; Patient Care; Patients; Persons; Pilot Projects; Process; Provider; Randomized; Reading; Recording of previous events; Recovery; Recovery Support; Recurrence; Research; Research Personnel; Research Project Grants; Resources; Scientist; Services; Site; Solid; Standardization; Surgeon; Surveys; System; Testing; Time; Training; Transplant Recipients; Transplant Surgeon; Transplantation; Transplantation Surgery; United States; Work; acceptability and feasibility; addiction; alcohol intervention; alcohol relapse; alcohol use disorder; care coordination; career; career development; comorbidity; effectiveness outcome; effectiveness-implementation randomized trial; effectiveness/implementation trial; evidence base; feasibility testing; feasibility trial; implementation evaluation; implementation framework; implementation outcomes; implementation research; implementation science; improved; integrated care; intervention program; liver transplantation; medication compliance; medication nonadherence; meetings; member; model design; mortality; multi-component intervention; multidisciplinary; novel; outreach; patient engagement; pilot test; pilot trial; post-transplant; programs; randomized trial; relapse prevention; research and development; skill acquisition; skills; therapy development; transplant centers

PROJECT SUMMARY Rates of alcohol use disorder and alcohol associated liver disease requiring liver transplantation continue to rapidly rise. Return to alcohol use after liver transplant is associated with increased rates of liver transplant failure and mortality, but there is no evidence-based integrated intervention to address alcohol use disorder in liver transplant recipients. The goal of this K23 award application submitted by a liver transplant surgeon is to address a critical gap in knowledge and care for liver transplant recipients with concurrent alcohol use disorder by developing and pilot testing an integrated liver transplant and alcohol recovery program (ILTARP) consisting of an integrated community health worker supporting post-transplant alcohol relapse prevention, outreach, and care coordination. To address this knowledge gap, I propose three research aims. Aim 1 is to co-develop the ILTARP intervention with stakeholder and expert input though an iterative process of evidence gathering and stakeholder panels. Aim 2 will conduct a pilot feasibility study of the newly developed ILTARP intervention testing feasibility, acceptability, and potential effectiveness of ILTARP in the liver transplant clinical setting through a randomized control pilot trial (n=40). Aim 3 will assess barriers and facilitators of the ILTARP intervention through an integrated mixed methods approach to prepare the intervention for a future R01 application for a fully powered multisite Hybrid Type 1 effectiveness-implementation trial. My long-term goal is to be an independently funded researcher developing, testing and implementing interventions in solid organ transplantation integrating care of complex co-occurring health conditions. The research aims directly inform my three training goals: Goal 1 to gain advanced knowledge in alcohol use disorder treatment and addictions research; Goal 2 to acquire skills in intervention development and randomized trials of multi-component interventions; and Goal 3 to develop expertise applying implementation research frameworks and evaluating implementation outcomes through the use of mixed methods. The training plan includes guided reading, mentored research projects, monthly seminars, and selected coursework, planned research manuscripts, and frequent mentor meetings to review progress. The research project, the research environment, and the exceptional multidisciplinary mentorship team (Drs. Bartels, Kelly, Aschbrenner) and consultants (Drs. Cameron, Wakeman, Cheng) are ideally suited to my career development. Overall, this career development award will provide the opportunity for me to acquire the necessary research skills to advance my career goal to become a leading expert in intervention development and implementation research in solid organ transplantation integrating care of complex co-occurring health conditions. This formative work has the potential to result in a paradigm shift in liver transplant centers across the nation by broadly disseminating ILTARP to improve access, equity, and long-term outcomes for the growing number of patients suffering from alcohol use disorder and alcohol associated liver disease.

项目摘要 需要肝移植的酒精使用障碍和与酒精相关的肝病的发生率继续 快速上升。肝移植后恢复饮酒与肝移植率的增加有关 失败和死亡率，但没有基于证据的综合干预来解决酒精使用障碍 肝移植接受者。肝移植外科医生提交的此K23颁发申请的目标是 解决同时使用酒精饮酒障碍的肝移植接受者知识和护理方面的关键差距 通过开发和试点测试综合的肝移植和酒精恢复计划（ILTARP） 支持移植后酒精复发，外展和的综合社区卫生工作者 护理协调。为了解决这一知识差距，我提出了三个研究目标。目标1是共同开发 通过迭代的证据收集过程和 利益相关者面板。 AIM 2将对新开发的ILTARP干预进行试验可行性研究 测试ILTARP在肝移植临床环境中的可行性，可接受性和潜在有效性 通过随机对照试验试验（n = 40）。 AIM 3将评估Iltarp的障碍和促进者 通过综合混合方法的干预措施为将来的R01准备干预措施 申请全功率的多站点混合型1型有效性实施试验。 我的长期目标是成为一名独立资助的研究人员，开发，测试和实施 固体器官移植的干预措施整合了复杂同时发生的健康状况的护理。这 研究目的直接告知我的三个培训目标：目标1以获取酒精使用的高级知识 障碍治疗和成瘾研究；目标2以获取干预开发方面的技能和 多组分干预措施的随机试验；和目标3用于应用实施的专业知识 研究框架和通过使用混合方法来评估实施结果。培训 计划包括指导阅读，指导研究项目，每月研讨会和选定课程， 计划的研究手稿和频繁的导师会议以审查进度。研究项目， 研究环境和卓越的多学科指导团队（Bartels博士，凯利，阿什布伦纳） 和顾问（Cameron博士，Cheng，Cheng）非常适合我的职业发展。 总体而言，该职业发展奖将为我提供必要的机会 研究技能，以促进我的职业目标，成为干预开发领域的领先专家 固体器官移植的实施研究，整合了复杂共同健康健康的护理 状况。这项形成性工作有可能导致跨越肝移植中心的范式转移 国家通过广泛传播Iltarp来改善访问，公平和长期结果 患有酒精疾病和酒精相关肝病的患者数量越来越多。