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Principal Investigator: Karsten Bartels
Organization: UNIVERSITY OF NEBRASKA MEDICAL CENTER
Fiscal Year: 2024
Award: $330,829
Funding agency: National Institute on Alcohol Abuse and Alcoholism
Abstract
Alcohol consumption adversely affects up to 28% of hospitalized patients and contributes to a loss of 133 million
disability-adjusted life years and 5.3% of worldwide deaths each year. As alcohol use has substantial health and
economic impact, much attention has been directed toward the numerous adverse health outcomes in patients
with unhealthy alcohol use. Alcohol use disorder (AUD) occurs on a spectrum from mild to severe and is
precipitated by binge drinking and heavy alcohol use. We and others have shown that AUD is a modifiable
perioperative risk factor and is present in up to 18% of surgical patients. Despite its significant clinical impact,
AUD is often overlooked in the design of perioperative care plans. Although AUD affects 9% of the US population,
less than one in ten individuals with AUD receives any treatment. Barriers to treatment are multiple and include
scarce care availability, limited access, and social stigma. Although anesthesiologists routinely provide guideline-
concordant treatment for non-operative medical conditions such as coronary artery disease, AUD-specific care
is rarely provided, even to high-risk patients. Thus, there is a compelling opportunity to integrate AUD screening
and treatment into routine perioperative care. Our central hypotheses are that AUD health services initiated in
the perioperative period will 1) leverage the significant resources made available to perioperative care in the US,
2) forge novel synergistic alliances between previously disconnected healthcare settings, and 3) break down
barriers to access to care for health disparity populations. A multi-institutional team of anesthesiologists,
biostatisticians, psychologists, and psychiatrists with expertise in AUD treatment and novel clinical trial designs
will lead the Leveraging Alcohol Use Disorder Screening for Treatment in Routine Perioperative
Care: AllUsCare proposal and proposes three aims: 1) Leverage our existing EHR-integrated Alcohol Use
Disorders Identification Test-Concise (AUDIT-C) screening tool to increase provision of AUD-specific
perioperative care, 2) Conduct a two-center prospective observational cohort study to assess patient
acceptability of interventions, feasibility of outcome data collection, and optimum outcome measures for a future
pragmatic trial, and 3) Optimize perioperative AUD intervention bundles most likely to be effective in a future
pragmatic randomized factorial cluster trial through a health equity lens. This R34 planning grant will lay the
groundwork for identifying the most effective health service intervention bundles in surgical patients at high risk
for AUD. To maximize inclusion of NIH health disparity populations, we will conduct our study in two centers that
serve inner-city and rural populations and will deliberately include patients aged 12 years and older. At the
conclusion of AllUsCare, we will have established the research team, designed an AUD intervention bundle most
likely to be effective in a future multi-center pragmatic trial, demonstrated a single-IRB governed uniform data
collection and entry process, and confirmed the acceptability and feasibility of the future pragmatic trial.
Terms: <12 year old><12 years of age><Affect><Alcohol Drinking><Alcohol consumption><Attention><Back><Behavior Conditioning Therapy><Behavior Modification><Behavior Therapy><Behavior Treatment><Behavioral Conditioning Therapy><Behavioral Modification><Behavioral Therapy><Behavioral Treatment><Caring><Cessation of life><Characteristics><Clinical><Clinical Trials Design><Conditioning Therapy><Coronary Arteriosclerosis><Coronary Artery Disease><Coronary Artery Disorder><Coronary Atherosclerosis><DALY><DSM-5><DSM-V><DSM5><Data><Data Collection><Death><Diagnostic and Statistical Manual of Mental Disorders, 5th edition><Diagnostic and Statistical Manual of Mental Disorders-V><Dorsum><EtOH drinking><EtOH use><Future><Grant><Guidelines><Health><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Health Services><Healthcare><Heavy Drinking><Hospital Admission><Hospitalization><IRB><IRBs><Individual><Institution><Institutional Review Boards><Intervention><Intervention Strategies><Measures><Medical><Medicare><Mental Health><Mental Hygiene><Methods><Multi-Institutional Clinical Trial><Multi-center clinical trial><Multi-site clinical trial><Multicenter clinical trial><Multisite clinical trial><NIAAA><NIDA><NIH><National Institute of Drug Abuse><National Institute on Alcohol Abuse and Alcoholism><National Institute on Drug Abuse><National Institutes of Health><Nursing Staff><Operative Procedures><Operative Surgical Procedures><Outcome><Outcome Assessment><Outcome Measure><Patients><Perioperative><Perioperative Care><Population><Process><Provider><Psychiatrist><Psychological Health><Psychologist><Qualitative Research><Randomized><Research><Research Priority><Research Resources><Resources><Risk><Risk Factors><Rural Population><Rural group><Rural people><Sampling><Screening procedure><Substance Use Disorder><Surgical><Surgical Interventions><Surgical Procedure><Testing><Title 18><United States National Institutes of Health><acceptability and feasibility><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><age 12 years><aged><alcohol abuse therapy><alcohol abuse treatment><alcohol ingestion><alcohol initiation><alcohol intake><alcohol intervention><alcohol misuse><alcohol product use><alcohol seeking><alcohol seeking behavior><alcohol treatment><alcohol use><alcohol use disorder><alcohol use initiation><alcoholic beverage consumption><alcoholic drink intake><atherosclerotic coronary disease><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><behavior intervention><behavioral health><behavioral intervention><binge alcohol consumption><binge drinking><cluster trial><coronary arterial disease><cost><design><designing><disability-adjusted life years><disparity in health><drink heavily><drinking><drinking initiation><economic impact><episodic drinking><ethanol consumption><ethanol drinking><ethanol ingestion><ethanol intake><ethanol misuse><ethanol product use><ethanol seeking><ethanol use><ethanol use disorder><ethanol-seeking behavior><excessive alcohol consumption><excessive alcohol ingestion><excessive alcohol intake><excessive drinking><excessive ethanol ingestion><extreme drinking><forging><health care><health care access><health care availability><health care service access><health care service availability><health care settings><health disparity><health disparity community><health disparity group><health disparity populations><health equity><health insurance for disabled><healthcare access><healthcare accessibility><healthcare availability><healthcare service access><healthcare service availability><healthcare settings><heavy alcohol use><high risk><inner city><interventional strategy><malleable risk><measurable outcome><modifiable risk><multi-component intervention><multi-faceted intervention><multi-modal intervention><multicomponent intervention><multifaceted intervention><multimodal intervention><multiphase optimization strategy><novel><nursing personnel><observational cohort study><obstacle to care><obstacle to healthcare><outcome measurement><participant engagement><patient engagement><pharmacologic><pragmatic effectiveness trial><pragmatic trial><prospective><randomisation><randomization><randomly assigned><rural individual><screening><screening tools><screenings><secondary outcome><service intervention><social stigma><stigma><substance use and disorder><surgery><surgery risk><surgical risk><timeline><twelve year old><twelve years of age><unhealthy alcohol use>