UW Department of Family Medicine and Community Health (DFMCH) Assistant Professor Andrew Quanbeck, PhD, will lead two new National Institutes of Health (NIH)-funded projects aimed at implementing interventions for the prevention and treatment of substance misuse in the primary-care setting.
Both awards are 5-year, NIH R01 grants representing nearly $5 million in total funding.
Helping Primary-Care Patients Use an App to Reduce Drinking
One project, funded by the National Institute on Alcoholism and Alcohol Abuse, will investigate how A-CHESS, a smartphone app that monitors the activity of people with alcohol-use disorders (AUD) and delivers interventions as needed, can facilitate healthier drinking patterns among primary-care patients.
Originally developed by David Gustafson, PhD, a research professor in the UW-Madison College of Engineering, A-CHESS has been proven effective for patients leaving residential treatment programs for AUD.
But using the app in primary care brings unique challenges, including clinician engagement and integration into the electronic health record (EHR).
To determine whether the potential benefit justifies those efforts, Dr. Quanbeck’s team will conduct a Type 2 hybrid effectiveness/implementation study—a type of study that measures not only patient outcomes, but also tests different implementation strategies.
First, they’ll recruit 546 patients with diagnosed AUD from primary-care clinics and randomly assign them to one of three groups:
- A usual-care group, in which patients are typically referred to a specialty addiction treatment clinic and little treatment is delivered by the primary-care physician;
- A “patient-directed” group, in which patients will use A-CHESS independently; and
- A “clinician-mediated” group, in which A-CHESS data are integrated into the EHR, and patients give clinicians permission to monitor their use of the app and interact with them through a clinician dashboard.
The team will then measure A-CHESS’s impact on risky drinking days, quality of life, healthcare utilization and cost; conduct a qualitative analysis of the A-CHESS itself and its integration with the EHR; and conduct a cost analysis of independent versus integrated use of the app.
“This will help us understand whether it’s worthwhile to integrate A-CHESS into primary-care clinical processes, or if it’s sufficient for patients to use it on their own,” Dr. Quanbeck said.
Integrating Opioid Prescribing Guidelines into Practice
The second project, funded by the National Institute on Drug Abuse, builds on preliminary research to improve physician adherence to clinical guidelines for opioid prescribing for patients with chronic, non-cancer pain.
In a pilot study, Dr. Quanbeck and colleagues Randall Brown, MD, PhD, DFASAM, and Aleksandra Zgierska, MD, PhD, distilled the guidelines into a succinct implementation guide. They then provided six months of coaching for clinical teams at four UW Health family medicine clinics, focusing on opioid dose, mental health screening, treatment agreements and urine drug testing.
Their efforts resulted in an 11 percent reduction in opioid doses in those clinics.
With the new grant, they will expand the project to 38 clinics in three health systems throughout Wisconsin.
The study will test an adaptive systems consultation intervention, meaning that it will start with low-intensity strategies, such as physician-led training and monthly audit and feedback reporting, and later add higher-intensity strategies such as facilitation and peer coaching.
“This iterative approach addresses differences in clinics’ and providers’ need for support around opioid prescribing,” Dr. Quanbeck explains. “It allows us to try a strategy, see if it’s working, and if not, switch or add strategies. It’s a pragmatic way to approach implementation and may be adaptable to other settings or diseases.”
The Role of an Implementation Researcher
Dr. Quanbeck is an implementation researcher and health-systems engineer. His work is fundamentally about optimizing patient care delivery through systems approaches, and, ultimately, seeking to provide the best care science has to offer to all patients in the healthcare system.
“These two projects specifically focus on addiction medicine, but implementation science applies to virtually any clinical domain,” he says.
And while receiving two NIH R01 grants in two months is a remarkable academic accomplishment, he wants to emphasize his gratitude for the tremendous support he’s received from funders, collaborators and mentors—at UW-Madison, the College of Engineering and the School of Medicine and Public Health. “I’m grateful to so many people who have helped me in my career: in particular, Dave Gustafson, Randall Brown, Maureen Smith, Val Gilchrist, Jane Mahoney, Bobbie Johnson, and Nick Schumacher. There’s no way I could have done any of this without their support.”
To learn more about these specific projects or the overall role of implementation science in healthcare research, contact Dr. Quanbeck at firstname.lastname@example.org.
Published: September 2018