Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial
Abstract Background Unhealthy alcohol use, a spectrum of use inclusive of risky consumption and alcohol use disorder (AUD), is a leading cause of preventable death in the United States. Most people with unhealthy alcohol use do not receive evidence-based treatment. This four-arm factorial design ran...
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BMC
2025-02-01
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| Series: | Addiction Science & Clinical Practice |
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| Online Access: | https://doi.org/10.1186/s13722-024-00526-x |
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| author | Kara M. Magane Richard Saitz Sarah Fielman Marc R. LaRochelle Christopher W. Shanahan Christine A. Pace Michael LaValley Kaley Penington Skylar Karzhevsky Emily Hurstak |
| author_facet | Kara M. Magane Richard Saitz Sarah Fielman Marc R. LaRochelle Christopher W. Shanahan Christine A. Pace Michael LaValley Kaley Penington Skylar Karzhevsky Emily Hurstak |
| author_sort | Kara M. Magane |
| collection | DOAJ |
| description | Abstract Background Unhealthy alcohol use, a spectrum of use inclusive of risky consumption and alcohol use disorder (AUD), is a leading cause of preventable death in the United States. Most people with unhealthy alcohol use do not receive evidence-based treatment. This four-arm factorial design randomized trial will assess whether population health management (PHM) and clinical care management (CCM) support for primary care providers (PCPs) are associated with improved AUD treatment engagement among their patients, beyond electronic health record (EHR) prompting and decision support alone. Methods PCPs from an urban safety-net hospital-based primary care clinic are randomized to one of four groups (1) EHR best practice advisory (BPA) and clinical decision support tools for unhealthy alcohol use (BPA), (2) BPA plus population health manager support, (3) BPA plus clinical care manager support, and (4) all three. All PCPs will have access to the EHR BPA and decision support tools which provide chart-based advisories and order set navigation. PCPs assigned to receive PHM support will receive quarterly panel-level feedback on AUD treatment metrics for their patients. PCPs assigned to receive CCM support will receive CCM facilitation of AUD treatment processes including medication counseling, referrals, and support through direct patient interactions. The primary outcome will be the percent of patients engaged in AUD treatment among those with a new AUD diagnosis on a PCP’s panel. Secondary outcomes include the percent of patients with a new diagnosis of AUD who (1) initiated AUD treatment, (2) were prescribed AUD medications within 90 days, and (3) numerical counts of a range of AUD health services (outpatient encounters, specialty AUD care encounters, referrals, and acute healthcare utilization) in this sample. We will assess the primary outcome and the acute healthcare utilization secondary outcomes using Medicaid claims; the remaining secondary outcomes will be assessed using EHR data. Discussion The study will evaluate how a targeted EHR innovation alone, compared with population health and care management enhancements alone or in combination, impact engagement in AUD treatment, a national quality of care measure. Findings will advance understanding of supports needed to improve systems of care for AUD in general settings. Trial registration ClinicalTrials.gov identifier/registration number (NCT number): NCT05492942 |
| format | Article |
| id | doaj-art-96d4be9b1a134994ac5d1354c2b7a1fa |
| institution | Kabale University |
| issn | 1940-0640 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj-art-96d4be9b1a134994ac5d1354c2b7a1fa2025-02-09T12:49:13ZengBMCAddiction Science & Clinical Practice1940-06402025-02-0120111110.1186/s13722-024-00526-xSupporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trialKara M. Magane0Richard Saitz1Sarah Fielman2Marc R. LaRochelle3Christopher W. Shanahan4Christine A. Pace5Michael LaValley6Kaley Penington7Skylar Karzhevsky8Emily Hurstak9Department of Community Health Sciences, Boston University School of Public HealthDepartment of Community Health Sciences, Boston University School of Public HealthDepartment of Community Health Sciences, Boston University School of Public HealthSection of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical CenterSection of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical CenterSection of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical CenterDepartment of Biostatistics, Boston University School of Public HealthTalent GroupsDepartment of Health Law, Policy & Management, Boston University School of Public HealthSection of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical CenterAbstract Background Unhealthy alcohol use, a spectrum of use inclusive of risky consumption and alcohol use disorder (AUD), is a leading cause of preventable death in the United States. Most people with unhealthy alcohol use do not receive evidence-based treatment. This four-arm factorial design randomized trial will assess whether population health management (PHM) and clinical care management (CCM) support for primary care providers (PCPs) are associated with improved AUD treatment engagement among their patients, beyond electronic health record (EHR) prompting and decision support alone. Methods PCPs from an urban safety-net hospital-based primary care clinic are randomized to one of four groups (1) EHR best practice advisory (BPA) and clinical decision support tools for unhealthy alcohol use (BPA), (2) BPA plus population health manager support, (3) BPA plus clinical care manager support, and (4) all three. All PCPs will have access to the EHR BPA and decision support tools which provide chart-based advisories and order set navigation. PCPs assigned to receive PHM support will receive quarterly panel-level feedback on AUD treatment metrics for their patients. PCPs assigned to receive CCM support will receive CCM facilitation of AUD treatment processes including medication counseling, referrals, and support through direct patient interactions. The primary outcome will be the percent of patients engaged in AUD treatment among those with a new AUD diagnosis on a PCP’s panel. Secondary outcomes include the percent of patients with a new diagnosis of AUD who (1) initiated AUD treatment, (2) were prescribed AUD medications within 90 days, and (3) numerical counts of a range of AUD health services (outpatient encounters, specialty AUD care encounters, referrals, and acute healthcare utilization) in this sample. We will assess the primary outcome and the acute healthcare utilization secondary outcomes using Medicaid claims; the remaining secondary outcomes will be assessed using EHR data. Discussion The study will evaluate how a targeted EHR innovation alone, compared with population health and care management enhancements alone or in combination, impact engagement in AUD treatment, a national quality of care measure. Findings will advance understanding of supports needed to improve systems of care for AUD in general settings. Trial registration ClinicalTrials.gov identifier/registration number (NCT number): NCT05492942https://doi.org/10.1186/s13722-024-00526-xAlcoholismAlcohol-related disordersElectronic health recordsPrimary care |
| spellingShingle | Kara M. Magane Richard Saitz Sarah Fielman Marc R. LaRochelle Christopher W. Shanahan Christine A. Pace Michael LaValley Kaley Penington Skylar Karzhevsky Emily Hurstak Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial Addiction Science & Clinical Practice Alcoholism Alcohol-related disorders Electronic health records Primary care |
| title | Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial |
| title_full | Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial |
| title_fullStr | Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial |
| title_full_unstemmed | Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial |
| title_short | Supporting primary care clinicians in caring for patients with alcohol use disorder: study protocol for Records for Alcohol Care Enhancement (RACE), a factorial four-arm randomized trial |
| title_sort | supporting primary care clinicians in caring for patients with alcohol use disorder study protocol for records for alcohol care enhancement race a factorial four arm randomized trial |
| topic | Alcoholism Alcohol-related disorders Electronic health records Primary care |
| url | https://doi.org/10.1186/s13722-024-00526-x |
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