INtervention in Small Primary care practices to Implement Reduction in unhealthy alcohol usE (INSPIRE)

对小型初级保健实践进行干预，以减少不健康的饮酒行为（INSPIRE）

• 批准号: 10260395
• 负责人: ABEL N KHO
• 金额: $ 51.96万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10260395
• 关键词: INtervention; Small; Primary; care; practices

ABSTRACT Unhealthy alcohol use is a leading cause of preventable mortality and a risk factor for an array of social and health problems with an estimated annual economic impact of $249 billion. Despite the significant public health impact of unhealthy alcohol use, rates of screening across the country remain low. In Illinois and Wisconsin, two states with the highest levels of unhealthy alcohol use in the Midwest, less than 17% of patients receive screening in a primary care setting and only 5% of patients with reported heavy alcohol use receive treatment. Effective screening and treatment in small practices is limited by lack of clinician education around screening and management, low rates of prescribing medications for alcohol use disorder, poor availability of referral programs, and difficulty integrating interventions into existing clinical workflows. Checklist-based screening tools present a simple, easy to understand strategy and have been successfully applied within the healthcare setting. In this project, we aim to test the feasibility and effectiveness of office-based screening supported by behavioral and medication-based interventions in primary care practices, through an integrated platform of education, practice facilitation, and embedded EHR technology. The project brings together a complementary team of experts from academic institutions, a quality improvement organization, practice-based research networks and independent research organizations, a majority of whom have previously worked together to implement similar office-based interventions supported by practice facilitation to improve cardiovascular care. Our specific aims are to 1) Develop and deploy online CME education programs to support the in-clinic implementation of behavioral intervention and medication assisted treatment for people with unhealthy alcohol use and identify patients who may benefit from further referral. 2) Conduct a practice randomized stepped wedge trial in small primary care practices to determine the adoption and efficacy of an EHR-based checklist to improve screening and treatment for people with unhealthy alcohol use. 3) Evaluate the ability of small practices in our region to participate in practice education programs and implement and sustain standard screening and treatment protocols adapted for documentation in the EHR and identify the factors that facilitated or hindered improvement and sustainability using quantitative and qualitative analysis methods. An important outcome of our program will be a robust, sustainable education and quality improvement infrastructure that can be deployed and disseminated throughout our region to support reduction of unhealthy alcohol use.

抽象的 不健康的饮酒是导致可预防死亡的主要原因，也是一系列社会和健康问题的危险因素。 健康问题预计每年造成 2,490 亿美元的经济影响。尽管公共卫生影响重大 尽管不健康饮酒的影响，全国范围内的筛查率仍然很低。在伊利诺伊州和威斯康星州， 中西部不健康饮酒水平最高的两个州，不到 17% 的患者接受 在初级保健机构中进行筛查，只有 5% 报告酗酒的患者接受治疗。 由于缺乏有关筛查的临床医生教育，小型诊所的有效筛查和治疗受到限制 和管理、酒精使用障碍处方药率低、转诊可用性差 计划，并且难以将干预措施整合到现有的临床工作流程中。基于清单的筛查 工具提供了一种简单、易于理解的策略，并已成功应用于医疗保健领域 环境。在这个项目中，我们的目标是测试基于办公室的筛查的可行性和有效性， 通过综合平台对初级保健实践进行基于行为和药物的干预 教育、实践便利和嵌入式 EHR 技术。该项目汇集了互补的 来自学术机构的专家团队、质量改进组织、基于实践的研究 网络和独立研究组织，其中大多数以前曾合作过 在实践促进的支持下实施类似的基于办公室的干预措施，以改善心血管护理。 我们的具体目标是 1) 开发和部署在线 CME 教育计划以支持临床 对不健康酗酒者实施行为干预和药物辅助治疗 使用并识别可能从进一步转诊中受益的患者。 2）进行随机步骤练习 在小型初级保健实践中进行楔形试验，以确定基于电子病历的清单的采用和有效性 改善对不健康饮酒者的筛查和治疗。 3）评估小公司的能力 我们地区的实践参与实践教育计划并实施和维持标准 适合 EHR 中记录的筛查和治疗方案，并确定影响因素 使用定量和定性分析方法促进或阻碍改进和可持续性。一个 我们计划的重要成果将是稳健、可持续的教育和质量提高 可以在整个地区部署和传播的基础设施，以支持减少不健康现象 酒精的使用。