Transition to Recovery

过渡到恢复

基本信息

批准号：
10310687
负责人：
SPERO MARTIN MANSON
金额：
$ 21.01万
依托单位：
WASHINGTON STATE UNIVERSITY
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：
2017-12-15 至 2024-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10310687
关键词：
Acute Address Admission activity Aftercare Alaska Alaska Native Alcohol consumption Alcohols Ambulatory Care American Indians Cessation of life Clinic Communication Computerized Medical Record Cost Effectiveness Analysis Cost-Benefit Analysis Data Drug Metabolic Detoxication Education Effectiveness Enrollment Ethnic Origin Evaluation Failure Focus Groups Fostering General Population Goals Health Healthcare Healthcare Systems Homelessness Impairment Inpatients Intervention Intoxication Medical Mental Health Modeling Morbidity - disease rate Mothers Native-Born Outcome Participant Patients Pattern Periodicity Persons Population Predictive Factor Process Provider Race Randomized Randomized Controlled Trials Recovery Research Research Project Grants Resources Role Screening for cancer Severities Social support Source Substance abuse problem Symptoms Testing Time Training Transportation Vulnerable Populations Withdrawal Work addiction alcohol abuse therapy alcohol research alcohol risk alcohol use disorder care coordination cost cost effective cost estimate economic evaluation economic value effective intervention experience health administration health disparity populations high risk hospital readmission improved meetings mortality motivational enhancement therapy outpatient programs patient oriented patient population post intervention prevent primary outcome programs randomized trial readmission rates rural patients social treatment program

项目摘要

RESEARCH PROJECT 3 ABSTRACT The primary goal of alcohol detoxification is to medically manage acute intoxication and withdrawal. Its secondary goal of fostering entry into longer-term alcohol treatment post-detoxification is often overlooked. This leads to a revolving door characterized by a cyclical pattern of discharges and readmissions to detoxification. This pattern is observed across the US among alcohol detoxification patients and is even more prevalent among Alaska Native people in Fairbanks where only 2% transition to alcohol treatment following detoxification and approximately 40% are readmitted within 1 year. The revolving door is costly to patients and providers. Current estimates associated with the cost of detoxification are not available. A study over 25 years ago indicated the average inpatient detoxification stay was over $3,300. Although the Substance Abuse and Mental Health Administration recognizes that better linkages are needed to transition people to treatment following detoxification, few interventions have tested ways to improve this transition; none of these prior studied included either Alaska Natives or American Indians. In partnership with the Fairbanks Native Association’s Gateway to Recovery (GTR), we propose to use patient navigators to guide and assist patients in transitioning to appropriate levels of treatment, and to help eliminate barriers that obstruct treatment entry. Our study first uses GTR’s electronic medical record data to identify factors that predict transition to treatment and readmission to detoxification among ~1,000 patients seen over the prior 5 years. Second, we will use this information, combined with focus groups comprised of key stakeholders, to identify appropriate navigator roles and processes for alcohol detoxification patients. We will then conduct a randomized controlled trial of the modified intervention with 700 patients. Third, we will estimate the costs of implementing and sustaining this intervention, Transition to Recovery, as well as its economic value. Our control condition will include 1 session of motivational interviewing that will include goal setting and strategies to reduce alcohol consumption after detoxification discharge. Our Specific Aims are to: 1) Use electronic medical record data from ~1,000 patients to identify factors associated with post-detoxification transition to alcohol treatment and readmission to detoxification; 2) Adapt Transition to Recovery to fit the GTR patient population and test its effectiveness in increasing transition to post-detoxification treatment within 30 days and prevent readmission within 1 year; and 3) Perform a comprehensive economic evaluation of Transition to Recovery by using cost-benefit and cost- effectiveness analyses. This is the first randomized controlled intervention to use patient navigators to enhance transition to alcohol treatment following detoxification. If effective, this intervention may be a cost-effective means of transitioning detoxification patients to treatment across health care systems nationally.

研究项目3摘要酒精排毒的主要目标是通过医学管理急性渗透和戒断。它是经常忽略了培养长期酒精治疗后进入长期酒精治疗的次要目标。这导致了一个旋转门，其特征是循环的出院和再入院模式解毒。在酒精解毒患者中，整个美国都观察到这种模式，甚至更多在费尔班克斯的阿拉斯加土著人民中普遍存在，那里只有2％过渡到酒精治疗后排毒和大约40％在1年内被回收。旋转门对患者和提供者。与排毒成本相关的当前估计值不可用。一项25年以上的研究 AGO表示，平均住院排毒停留时间超过3,300美元。虽然药物滥用和心理健康管理局认识到，将人们转变为治疗需要更好的联系解毒后，很少有干预措施测试了改善这种过渡的方法。这些都没有研究了，包括阿拉斯加土著人或美国印第安人。与Fairbanks本地人合作协会的恢复门户（GTR），我们建议使用患者导航员指导和协助患者过渡到适当的治疗水平，并有助于消除阻碍治疗的障碍。我们的研究首先使用GTR的电子病历数据来确定预测过渡到治疗和的因素在过去5年中看到的约1,000名患者中排毒的再入院。第二，我们将使用此信息，结合包括关键利益相关者的焦点小组，以确定适当的导航角色和酒精解毒患者的过程。然后，我们将进行一项随机对照试验对700名患者进行了修改。第三，我们将估计实施和维持这一目标的成本干预，向恢复过渡以及其经济价值。我们的控制条件将包括1个会话动机面试将包括目标设定和减少酒精消耗之后的策略解毒排放。我们的具体目的是：1）使用来自约1,000名患者的电子病历数据确定与二氧化后过渡到酒精治疗和再入院相关的因素解毒； 2）适应恢复过渡以适合GTR患者人群并测试其在在30天内增加过渡到氧化后治疗的过渡，并在1年内防止再入院；和 3）通过使用成本效益和成本 - 有效分析。这是第一个使用患者导航器增强的随机控制干预措施解毒后过渡到酒精治疗。如果有效，此干预可能是一种成本效益在全国范围内将排毒患者转变为跨卫生保健系统治疗的手段。