Dynamic Assessment and Referral System for Substance Abuse (DARSSA) Phase 2

药物滥用动态评估和转介系统 (DARSSA) 第 2 阶段

• 批准号: 7666250
• 负责人: Edwin D Boudreaux
• 金额: $ 60.11万
• 依托单位: POLARIS HEALTH DIRECTIONS, INC.
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2011-01-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7666250
• 关键词: Abstinence; Abuse Reporting; Accident and Emergency department; Address; Administrator; Adopted; Advisory Committees; Alcohol or Other Drugs use; Alcohols; Ambulatory Care Facilities; American; American Medical Association; Anxiety; Auditory; Behavior Therapy; Businesses; Cardiology; Caring; Characteristics; Clinical; Clinical Services; Computer Hardware; Computer software; Cost Savings; Counseling; Critiques; Current Procedural Terminology Codes; Data; Decision Making; Detection; Development; Documentation; Domestic Violence; Drug abuse; Drug usage; Education; Effectiveness; Electronic Health Record; Electronics; Emergency Medicine; Emergency Situation; Enrollment; Evaluation; Evaluation Studies; Evidence based practice; Exercise; Family Practice; Federal Government; Feedback; Foundations; Frequencies; Generations; Geographic Locations; Health; Health Care Costs; Health Personnel; Health behavior; Healthcare; Healthy People 2010; Human; Illicit Drugs; Individual; Inpatients; Insurance; Insurance Coverage; Internet; Intervention; Interview; Investments; Joint Commission on Accreditation of Healthcare Organizations; Joints; Laboratories; Lead; Letters; Libraries; Link; Marketing; Medical; Medicare; Mental Health; Methods; Modeling; Morbidity - disease rate; Motivation; National Committee for Quality Assurance; Online Systems; Outcome; Outpatients; Patients; Persons; Pharmaceutical Preparations; Phase; Physicians; Preclinical Drug Evaluation; Premature Mortality; Preventive; Printing; Process; Provider; Psychiatrist; Psychologist; Public Health; Readiness; Recommendation; Registries; Reporting; Research; Research Institute; Resources; Schedule; Screening procedure; Self-Administered; Services; Site; Small Business Technology Transfer Research; Substance abuse problem; Summary Reports; System; Telefacsimile; Test Result; Testing; Tobacco; United States; United States Centers for Medicare and Medicaid Services; Update; Victimization; Visit; Wireless Technology; Wood material; Work; alcohol and other drug; base; clinical care; commercialization; computerized; depression; design; falls; flexibility; health care service utilization; improved; innovation; interest; killings; medical schools; medical specialties; programs; psychosocial; public health relevance; research and development; response; screening and brief intervention; screening, brief intervention, referral, and treatment; self help; tobacco abuse; tool; treatment as usual; treatment response; ward

DESCRIPTION (provided by applicant): The majority of healthcare providers do not routinely screen, counsel, or refer patients who use or abuse tobacco, alcohol, or illicit drugs. This has far-reaching consequences, including excess morbidity, premature mortality, and inflated healthcare costs arising from unidentified and untreated substance abuse. To address this problem, Polaris Health Directions (Small Business Concern) and RWJMS (Research Institute) partnered for the development of the Dynamic Assessment and Referral System for Substance Abuse (DARSSA). All Phase 1 aims were achieved. The DARSSA's most important innovations include (1) providing a brief assessment that, in addition to substance abuse, covers a broad range of important, frequently co-occurring psychosocial problems (e.g., depression, domestic violence); (2) generation of separate reports tailored to the specific needs of the respective end-users; (3) highly tailored referrals for all three major drug classes -- tobacco, alcohol, and other drugs; and (4) an ability to transmit dynamic (electronic) referrals to a program matched to key patient characteristics. Key Phase 2 innovations include the addition of (5) an electronic health records interface, (6) a semi-automated referral provider registration, (7) expected treatment response profiles to assist in clinical decision making, (8) auditory item presentation, and (9) an evaluation of 2 different implementation models as a universal assessment and as a clinically indicated tool. The public health impact of such a program can be formidable if applied using system-based approaches. The Phase 2 Specific Aims are to (1) modify the DARSSA based on Phase 1 results and the initial review group's recommendations; (2) test the revised DARSSA to confirm the enhanced system's fidelity; and (3) evaluate the effectiveness the final DARSSA for improving substance detection, counseling, referral, treatment engagement, and abstinence. The Evaluation Study will use a reversal (A-B-A) design and will study integrating the DARSSA into routine clinical care in three different emergency departments (EDs). The primary difference between the baseline (A) and intervention (B) phases is that, during the intervention phases, the subjects will have their DARSSA reports printed and will be given the option of receiving the dynamic referral, while during the baseline phases the subjects will undergo the assessment only. The number of assessments and interactions with research staff will remain equal between the two conditions. We anticipate enrolling 810 risky substance users in the treatment-as-usual (control) condition and 486 in the DARSSA (intervention) condition. All risky substance users will be followed for 3-months. The DARSSA's commercial potential is considerable, with a favorable return on investment from: (1) increased compliance with the Joint Commission (formerly JCAHO) and other regulatory mandates, (2) increased reimbursement from improved documentation, (3) enhanced revenue generation through increased reimbursable counseling (e.g., Medicare), and (4) cost savings from reduced substance abuse. PUBLIC HEALTH RELEVANCE: The Dynamic Assessment and Referral for System for Substance Abuse (DARSSA) is an innovative product with potential to improve public health through identifying and linking patients who abuse tobacco, alcohol, or other drugs with treatment. The intervention is being studied in the emergency department (ED) setting to demonstrate its feasibility and utility in the most logistically challenging medical setting, but it is relevant for a broad array of healthcare settings ranging from outpatient offices to inpatient wards. Our study challenges existing paradigms that rely exclusively upon human-based screening, brief intervention, and referral to treatment (SBIRT) interventions for substance use, which are costly and, therefore, not commonly adopted in clinical settings.

描述（由申请人提供）：大多数医疗保健提供者不常规筛查，律师或转介使用或滥用烟草，酒精或非法药物的患者。这会带来深远的后果，包括过量的发病率，过早死亡和由于未知和未经治疗的药物滥用而产生的医疗费用膨胀。为了解决这个问题，Polaris Health指示（小型企业问题）和RWJMS（研究所）合作开发动态评估和滥用药物的转诊系统（DARSSA）。实现了所有阶段的目标。 DARSA最重要的创新包括（1）简短评估，除了滥用药物外，还涵盖了广泛的重要，经常共同发生的社会心理问题（例如，抑郁症，家庭暴力）； （2）生成针对各个最终用户的特定需求量身定制的单独报告； （3）所有三个主要药物类别的高度量身定制的转诊 - 烟草，酒精和其他药物； （4）将动态（电子）转介传输到与关键患者特征匹配的程序的能力。关键阶段2创新包括（5）电子健康记录接口，（6）半自动转诊提供商注册，（7）预期的治疗响应概况，以帮助临床决策，（8）听觉项目表现，以及（9）对2种不同实施模型的评估作为一种通用评估，并作为临床上的工具。如果使用基于系统的方法应用，这种计划的公共卫生影响可能会巨大。第2阶段的特定目的是（1）根据第1阶段的结果和初始审查小组的建议对DARSSA进行修改； （2）测试修订后的DARSSA以确认增强系统的保真度； （3）评估最终的DARSSA的有效性，以改善物质检测，咨询，转诊，治疗参与和禁欲。评估研究将使用逆转（A-B-A）设计，并将研究将DARSSA整合到三个不同的急诊科（ED）的常规临床护理中。基线（a）和干预（b）阶段之间的主要区别在于，在干预阶段，受试者将打印其DARSSA报告，并可以选择接收动态转诊，而在基线阶段，受试者将仅接受评估。在两个条件之间，评估和与研究人员的互动数量将保持平等。我们预计将在治疗（对照）条件下招募810种风险的药物使用者，而在DARSSA（干预）条件下会招募486种。将遵循所有危险的药物使用者3个月。 DARSA的商业潜力是可观的，有利的投资回报率从：（1）提高了对联合委员会（以前为JCAHO）和其他监管要求的依从性，（2）（2）通过改进的文档获得的报销增加了，（3）通过增加可偿还的咨询（E.G.，Medicare）和（4）成本滥用而增加了收入的收入产生。公共卫生相关性：药物滥用系统的动态评估和转诊（DARSSA）是一种创新的产品，具有通过识别和联系滥用烟草，酒精或其他药物与治疗的患者来改善公共卫生的潜力。该干预措施正在急诊科（ED）设置中进行研究，以证明其在最具挑战性的医疗环境中的可行性和实用性，但这与从门诊办公室到住院病房的广泛医疗机构相关。我们的研究挑战了现有的范式，这些范式仅依赖于人类基于人类的筛查，简短的干预和转诊（SBIRT）用于吸毒的干预措施，这些干预措施是昂贵的，因此在临床环境中并不常见。