Document text
Principal Investigator: Katherine J. Karriker-Jaffe
Organization: RESEARCH TRIANGLE INSTITUTE
Fiscal Year: 2024
Award: $783,430
Funding agency: National Institute on Alcohol Abuse and Alcoholism
PROJECT SUMMARY/ABSTRACT
Excessive drinking results in tremendous economic and social costs and is a leading cause of preventable
death in the US. Only a small minority of people with alcohol use disorder (AUD) receive appropriate
services, and there are large disparities in access to alcohol health services for people based on
race/ethnicity, gender, socioeconomic status, and urbanicity. The proposed study will answer pressing
questions about how to reduce disparities in access, using simulation modeling to examine whether
universal increases in access to evidence-based practices (EBPs) such as screening, brief intervention, and
referral to treatment (SBIRT) or medication-assisted treatment can reduce disparities, or whether more
targeted efforts to improve access are needed to reach high-priority population subgroups. Simulation
models are well-suited for identifying unintended consequences of interventions implemented in complex
systems, as well as outcomes that may occur years after implementation. By projecting intervention effects
across population subgroups over time, simulation modeling can help identify and prioritize types of alcohol
health services interventions to reduce AUD disparities. Although simulation methods are being used to
address the opioid crisis, to date there is no published simulation model comprehensively describing the
continuum of alcohol health services in relation to AUD disparities. The proposed study fills this gap by
simulating effects of increased access to alcohol health services across the continuum of care from SBIRT,
to specialty care (including AUD medications) and informal treatment (including 12-step groups like
Alcoholics Anonymous), in relation to health disparities. First, we will build and calibrate a microsimulation
model of alcohol health services for people with mild, moderate, and severe AUD, guided by a conceptual
model that includes barriers to treatment at the individual, organizational, community, and policy levels. Next,
we will use a geographically situated simulated population representing the large, demographically and
geographically diverse states of California and Texas to make long-term projections for AUD severity and
recovery for key population subgroups over time. Finally, informed by theories of healthcare access and
utilization, we will project changes in AUD treatment disparities under several enhanced conditions to identify
the mix and distribution of services that would best reduce disparities, and we estimate costs and benefits of
improved service access. Study Aims are to assess effects of (1) universal implementation of EBPs in
traditional and non-traditional settings and (2) improving accessibility, availability, affordability, and
acceptability of alcohol health services on disparities, and to (3) estimate cost and cost-effectiveness of
these changes. Results will provide detailed information to inform service planning by states, counties, and
communities to improve health services, including projections for how and where to intervene in a cost-
effective manner to reduce the burden of AUD and increase long-term recovery for vulnerable populations.
Terms: <AIDS Virus><Access to Care><Accident and Emergency department><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Address><Alcohol Chemical Class><Alcohol Drinking><Alcohol consumption><Alcoholics Anonymous><Alcohols><Calibration><California><Caring><Clinic><Communities><Complex><Continuity of Care><Continuity of Patient Care><Continuum of Care><Costs and Benefits><County><Data><Decrease disparity><Development><Dimensions><Disparities><Disparity><Distal><Drugs><Economics><Emergency Department><Emergency room><Espanol><EtOH drinking><EtOH use><Ethnic Origin><Ethnicity><Evaluation><Evidence based practice><Federally Qualified Health Center><Funding><Future><Gender><Geographic Area><Geographic Locations><Geographic Region><Geographical Location><Geography><Goals><HIV><Health Care Providers><Health Care Utilization><Health Personnel><Health Services><Health Services Accessibility><Healthcare Providers><Healthcare worker><Heavy Drinking><Human Immunodeficiency Viruses><Improve Access><Individual><Individuals from minority><Individuals of minority><Intervention><Intervention Strategies><Investigation><LAV-HTLV-III><Language><Literature><Lower disparity><Lymphadenopathy-Associated Virus><Medicaid><Medication><Mental Health><Mental Hygiene><Methods><Minority Groups><Minority People><Minority Population><Minority individual><Modeling><NIAAA><National Institute on Alcohol Abuse and Alcoholism><Outcome><Pattern><Persons><Pharmaceutical Preparations><Policies><Policy Maker><Population><Prenatal care><Primary Care><Probabilistic Models><Probability Models><Psychological Health><Publishing><Race><Races><Recovery><Recovery Support><Research><Research Resources><Resources><Role><Rural><SBIRT><Services><Severities><Slide><Socio-economic status><Socioeconomic Status><Spanish><Specialty><Specific qualifier value><Specified><Spottings><Statistical Computing><Statistical Models><Subgroup><Survey Instrument><Surveys><System><Testing><Texas><Time><United States><Urbanicity><Violence><Virus-HIV><Vulnerable Populations><Woman><access disparities><access to alcohol><access to health care><access to health services><access to healthcare><access to services><access to treatment><accessibility disparities><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><alcohol access><alcohol accessibility><alcohol availability><alcohol ingestion><alcohol intake><alcohol product use><alcohol related problem><alcohol use><alcohol use disorder><alcoholic beverage consumption><alcoholic drink intake><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><care access><college><collegiate><cost><cost effective><cost effective intervention><cost effectiveness><cost estimate><cost estimation><developmental><disparate effect><disparate impact><disparate result><disparities in access><disparities in treatment><disparity in health><disparity reduction><drink heavily><drinking><drug/agent><economic><ethanol accessibility><ethanol availability><ethanol consumption><ethanol drinking><ethanol ingestion><ethanol intake><ethanol product use><ethanol use><ethanol use disorder><excessive alcohol consumption><excessive alcohol ingestion><excessive alcohol intake><excessive drinking><excessive ethanol ingestion><extreme drinking><geographic site><health care access><health care availability><health care personnel><health care service access><health care service availability><health care service use><health care service utilization><health care settings><health care worker><health disparity><health provider><health service access><health services availability><health workforce><healthcare access><healthcare accessibility><healthcare availability><healthcare personnel><healthcare service access><healthcare service availability><healthcare service use><healthcare service utilization><healthcare settings><healthcare utilization><heavy alcohol use><improved><inequality in access><inequality in treatment><inequitable effect><inequitable impact><inequitable outcome><inequity in access><inequity in accessibility><insight><intervention effect><interventional strategy><long term recovery><medical personnel><medical specialties><medication-assisted therapy><medication-assisted treatment><mitigate disparity><model-based simulation><models and simulation><obstacle to care><obstacle to healthcare><opiate crisis><opioid crisis><opioid epidemic><outcome disparities><outcome inequality><outcome inequity><pregnancy care><prenatal appointment><prenatal checkup><prenatal visit><preventable death><preventable mortality><programs><racial><racial background><racial origin><reduce disparity><reduced alcohol use><reduction in disparity><scale up><screening><screening and brief intervention><screening, brief intervention, and referral to treatment><screening, brief intervention, referral, and treatment><screenings><service availability><service intervention><simulation><sober><sobriety><social><social role><socio-economic><socio-economic position><socio-economically><socioeconomic position><socioeconomically><socioeconomics><statistical linear mixed models><statistical linear models><statistical process><statistical reasoning><theories><treatment access><treatment disparity><treatment inequality><treatment inequity><treatment program><treatment provider><trend><under served area><under served geographic area><under served location><under served region><underserved area><underserved geographic area><underserved location><underserved region><unequal effect><unequal impact><unequal outcome><violent><violent behavior><vulnerable group><vulnerable individual><vulnerable people>