The American College of Surgeons mandate universal screening for alcohol misuse and delivery of a brief intervention for those screening positive as a requirement for certification as a level one trauma center. Though this requirement has been mandated for over a decade, its implementation has been challenging, especially for pediatric trauma centers. Our currently funded study, IAMSBIRT, tests the effectiveness of a comprehensive implementation strategy in increasing the implementation of SBIRT for alcohol and other drug (AOD) use in pediatric trauma centers through a Type III hybrid effectiveness-implementation trial. This goal is accomplished through: Primary Aim: Evaluate the effectiveness of the SSL implementation strategy in increasing fidelity of SBIRT delivery at pediatric trauma centers, relative to usual implementation; Secondary Aim 1: Evaluate whether readiness for organizational change mediates the influence of the SSL implementation strategy on implementation effectiveness (i.e., fidelity of SBIRT delivery); Secondary Aim 2: Evaluate the effect of the SSL implementation strategy on improving patient linkage to appropriate care (i.e., continued AOD discussion with primary care provider and/or AOD treatment) following discharge from pediatric trauma centers; and Exploratory Aim: Examine the integration of counseling regarding the use of prescription pain relievers into SBIRT delivery with injured adolescent patients who screen positive for AOD use. Utilizing a stepped wedge design, a national cohort of 10 pediatric trauma centers receive the SSL implementation strategy. At six distinct time points, each site provides data from a sample of thirty electronic health records (EHRs); a subset of adolescents report on fidelity of intervention delivery and linkage to care. Clinical staff from each pediatric trauma center report on organizational readiness for implementation at three distinct time points. The administrative supplement requested will expand our EHR review to be of all admitted adolescents across all wedges (including those already occurred) to examine providers? clinical notes 30 days post discharge for evidence of linkage to care (AOD follow up discussions/ AOD treatment) after the trauma center visit. This change is necessary to effectively examine Secondary Aim 2 given changes in the research protocol due to the COVID-19 pandemic. Results of this study will demonstrate that a highly scalable implementation strategy will improve the fidelity (i.e., the consistency and quality) of SBIRT delivery in pediatric trauma centers.
This research has the potential to significantly impact public health by improving SBIRT practices at pediatric trauma centers and direct more adolescent with alcohol or other drug use to needed services. The contribution of the proposed Type III hybrid effectiveness-implementation trial in testing the effectiveness of a comprehensive implementation strategy in increasing SBIRT for alcohol and other drug use in pediatric trauma centers has clinical importance, public health relevance and significance to implementation science.
| Mello, Michael J; Becker, Sara J; Bromberg, Julie et al. (2018) Implementing Alcohol Misuse SBIRT in a National Cohort of Pediatric Trauma Centers-a type III hybrid effectiveness-implementation trial. Implement Sci 13:35 |
