Implementing Mobile Technology for Unhealthy Alcohol Use in Emergency Departments

在急诊科实施移动技术以解决不健康的饮酒问题

• 批准号: 10577737
• 负责人: Megan Alison O'Grady
• 金额: $ 20.17万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10577737
• 关键词: Accident and Emergency department; Address; Administrator; Adopted; Adoption; Adult; Alcohol consumption; Alcohols; Area; COVID-19 pandemic; Caring; Collaborations; Country; Data; Effectiveness; Electronic Health Record; Eligibility Determination; Emergency Department patient; Emergency department visit; Enrollment; Frequencies; Future; General Population; Health Services; Health Technology; Health behavior; Health system; Individual; Intervention; Interview; Learning; Meta-Analysis; Methods; Nature; Outcome; Patients; Pilot Projects; Population; Premature Mortality; Process; Promoting Action on Research Implementation in Health Services framework; Provider; Randomized; Research; Research Support; Resources; Sampling; Site; Structure; Surveys; Technology; Testing; Text; Text Messaging; Time; Training; Trauma patient; United States; United States National Institutes of Health; Work; World Health; alcohol involvement; alcohol misuse; alcohol screening; arm; behavioral health intervention; comparison control; drinking; effectiveness/implementation trial; emergency settings; evidence base; health care settings; implementation barriers; implementation facilitators; implementation strategy; interest; intervention mapping; mHealth; mobile computing; patient screening; pragmatic implementation; randomized trial; reduced alcohol use; response; screening and brief intervention; screening program; substance use; text messaging intervention

Project Summary Unhealthy alcohol use (UAU) is one of the leading causes of premature mortality among adults in the United States and has been increasing during the COVID-19 pandemic. UAU is more frequent among emergency department (ED) patients than in the general population and ED visits involving alcohol consumption have increased in recent years. Substance use has been described as the most important modifiable health behavior in the ED, and the ED has been highlighted as a key setting to intervene with UAU individuals. Consequently, health systems across the country need low burden, scalable ways to intervene with individuals but often have limited time and resources. Mobile technologies have been suggested as a solution to assist EDs in addressing UAU and one of the lowest burden, scalable approaches are text messaging interventions. Text messaging interventions for ED and trauma patients and other populations have shown good outcomes, including reductions in drinking quantity and frequency. Despite strong research support and promise for scalability, there is little evidence that technology-based behavioral health interventions can be effectively implemented into healthcare settings. There are few studies in which technology interventions for behavioral health are put into real world healthcare settings; those that have been conducted show that the benefits seen in randomized trials are often not realized. While EDs are promising venues for addressing UAU using text messaging interventions, the process of providers making them available to patients in an efficient way within already busy and overburdened ED workflows (i.e., implementation in real-world ED settings) and patients adopting them remains a new area of research. This proposal builds on the longstanding collaboration of our interdisciplinary team on the implementation of substance use screening and brief interventions in healthcare settings. In response to the NIH Notice of Special Interest for Research in the Emergency Setting, we propose to examine potential barriers and facilitators to staff offering and patients accepting a text messaging intervention in the ED. We will then use a stakeholder-engaged Intervention Mapping process to develop a multi-component implementation strategy for EDs. Finally, we will conduct a mixed method 2-arm cluster- randomized pilot study in 4 EDs that serve ~13,000 UAU patients per year to assess the feasibility, acceptability and preliminary effectiveness of the implementation strategy. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide study activities. Low burden technology, like text messaging, along with targeted implementation support and strategies driven by identified barriers and facilitators could sustain large-scale ED-based alcohol screening programs and provide much needed support to patients who screen positive while reducing burden on EDs. The proposed study would be the first to develop and test this targeted implementation strategy. This 2-year R21 will prepare for a future, larger, fully-powered hybrid effectiveness-implementation trial.

项目摘要 不健康的饮酒（UAU）是曼联成年人过早死亡的主要原因之一 国家和期间共同大流行期间一直在增加。 UAU在紧急情况下更频繁 部门（ED）患者比一般人群和涉及饮酒的ED访问 近年来有所增加。药物使用已被描述为最重要的修改健康 ED中的行为和ED已被强调为与UAU个人进行干预的关键环境。 因此，全国各地的卫生系统需要低负担，可扩展的方式来干预个人 但是时间和资源通常有限。已建议将移动技术作为协助的解决方案 EDS解决UAU和最低负担之一，可扩展的方法是文本消息干预措施。 ED和创伤患者和其他人群的文本消息干预措施表现出良好的结果， 包括减少饮酒量和频率。尽管有强烈的研究支持和对 可伸缩性，几乎没有证据表明基于技术的行为健康干预措施可以有效地 实施到医疗机构中。很少有研究对行为的技术干预措施 健康被纳入现实世界的医疗机构；那些已经进行的表明，看到的好处 在随机试验中通常无法实现。埃德（Eds）是有希望使用文本解决UAU的场所 消息干预措施，提供者的过程使患者以有效的方式向患者提供 已经忙碌而负担重大的ED工作流（即，在现实世界中的设置中实施）和患者 采用它们仍然是一个新的研究领域。该提议建立在我们的长期合作的基础上 跨学科团队关于实施药物使用筛查和医疗保健的简短干预措施 设置。为了回应NIH在紧急情况下对研究的特殊兴趣通知，我们建议 检查潜在的障碍和促进者，以提供服务人员和接受文本消息传递的患者 急诊室干预。然后，我们将使用利益相关者参与的干预映射过程来开发 EDS的多组分实施策略。最后，我们将进行混合方法2臂簇 - 随机试验研究中的4 eds每年为约13,000名UAU患者提供服务，以评估可行性， 实施策略的可接受性和初步有效性。集成的促进行动 卫生服务（I-PARIHS）框架的研究实施将指导学习活动。负担低 技术，例如文本消息，以及针对性的实施支持和被确定的策略 障碍和促进者可以维持大规模的基于ED的酒精筛查计划，并提供很多 需要对筛选阳性的患者的支持，同时减轻ED负担。拟议的研究将是 第一个制定和测试此目标实施策略的人。这个为期两年的R21将为未来做准备， 大型，全功率的混合有效性实施试验。