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.

项目概要 需要肝移植的酒精使用障碍和酒精相关性肝病的发生率持续上升 迅速上升。肝移植后恢复饮酒与肝移植率增加有关 失败和死亡率，但没有基于证据的综合干预措施来解决酒精使用障碍 肝移植受者。肝移植外科医生提交的 K23 奖项申请的目标是 解决患有并发酒精使用障碍的肝移植受者在知识和护理方面的重大差距 通过开发和试点测试综合肝移植和酒精恢复计划（ILTARP），包括 综合社区卫生工作者支持移植后酒精复发预防、外展和 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 ILTARP 通过证据收集和评估的迭代过程，听取利益相关者和专家的意见进行干预 利益相关者小组。目标2将对新开发的ILTARP干预措施进行试点可行性研究 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 通过随机对照试点试验（n=40）。目标 3 将评估 ILTARP 的障碍和促进因素 通过综合混合方法进行干预，为未来的干预做好准备 R01 申请全功率多站点混合类型 1 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 实体器官移植的干预措施结合了复杂的并发健康状况的护理。这 研究目的直接影响我的三个培训目标： 目标 1 获得酒精使用方面的高级知识 疾病治疗和成瘾研究；目标 2 获得干预开发和 多成分干预措施的随机试验；目标 3 培养应用实施的专业知识 研究框架并通过使用混合方法评估实施结果。培训内容 计划包括指导阅读、指导研究项目、每月研讨会和选定的课程作业， 计划研究手稿，并经常召开导师会议来审查进展。该研究项目， 研究环境，以及杰出的多学科导师团队（Bartels、Kelly、Aschbrenner 博士） 和顾问（Cameron 博士、Wakeman 博士、Cheng 博士）非常适合我的职业发展。 总的来说，这个职业发展奖将为我提供获得必要的机会 研究技能，以推进我的职业目标，成为干预开发和领域的领先专家 实体器官移植整合复杂并发健康护理的实施研究 状况。这项开创性工作有可能导致肝移植中心的范式转变 通过广泛传播 ILTARP 来改善全国的准入、公平和长期成果 越来越多的患者患有酒精使用障碍和酒精相关性肝病。