Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study

Abstract

Background The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. Methods We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. Discussion By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions.

Substance use disorders and medical comorbidities among high-need, high-risk patients with diabetes

“…BHDs, especially SUDs, are understudied and under-treated among the costliest patient groups in primary care (Walter et al, 2017). With the support from Triple-Aim reforms and policy shifts toward value-based care, the time is right for allocating resources to investigate the magnitude of SUDs and associated comorbidities, and implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) approaches, as well as office-based treatment of alcohol and opioid use disorders for high-need, high-risk patients with diabetes (Levey et al, 2012; Melek et al, 2014; Walter et al, 2017; Wu et al, 2016). …”

Research Use of Electronic Health Records: Patients’ Views on Alternative Approaches to Permission

“…The widespread adoption and use of electronic health records (EHRs), driven by the Health Information Technology for Economic and Clinical Health Act (HITECH Act 2009) and integral to learning healthcare systems (Califf, Sanderson, and Miranda 2012; Institute of Medicine and National Academy of Engineering 2011), has made an unprecedented amount of information available not only for clinical care, but also for health-related research (Kukafka et al 2007;Menachemi and Collum 2011;National Research Council 2011;H€ ayrinen, Saranto, and Nyk€ anen 2008). EHRs are being increasingly used for research and clinical trial recruitment due to the depth and breadth of the information they contain as well as new technological tools to mine, assimilate, analyze, link, reproduce, and transmit information (Caine and Hanania 2013;Tan et al 2016;Wu et al 2016). For example, a process called "EHR phenotyping" allows researchers to identify cohorts of patients with precise attributes by applying highthroughput algorithms to EHR data to classify patients based on exact constellations of information (e.g., demographics, symptoms, diagnoses, procedures, laboratory values, vital signs, medications, lifestyle and environmental factors) (Hripcsak and Albers 2013;Boland, Hripcsak, et al 2013;Pathak, Kho, and Denny 2013;Richesson North Carolina (D); Mingo, West Virginia (M); and Quitman, Mississippi (Q) (Appendix A).…”

SENSIBLE: SEquestered aNd SynergIstic BLockchain Ecosystem

“…Electronic Health Records (EHRs) 1 were introduced with a broader aim of improving the planning and management of health services 2 . With advancements in health care and a multitude of health data sources, the use of EHRs is extended to access the relevant information of the patient's medical history when required, with an objective to deliver personalized health care 3‐6 . Personalized health care is the detailed study of an individuals and successive treatment according to their lifestyle, health traits, and metabolism.…”