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.

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.

Delays in diagnosis and referral and treatment for hematologic malignancies

The purpose of this thesis project was to identify factors that may contribute to a delay in the diagnosis, referral or treatment of the hematologic malignancies. This thesis is a secondary data analysis of both qualitative and quantitative data collected during a pilot study for a parent CDC study to determine factors related to time to diagnosis, referral, and treatment of chronic lymphocytic leukemia (CLL), chronic myelogenous leukemia (CML), multiple myeloma (MM), and myelodisplastic syndrome (MDS). To identify patterns for referral, as well as explore referral, treatment, and follow-up patterns, MDACC performed a pathways analysis, and conducted semi-structured interviews with hematologic cancer patients to help identify factors related to delays. Interviews were also conducted with primary care physicians and community hematologists/oncologists to help identify factors associated with optimal and sub-optimal patterns of diagnosis and referral. The results of these analyses suggest a set of factors that may be related to a fairly smooth and rapid trajectory to treatment, and factors that may be related to a slower, more disrupted trajectory. Factors that may be especially important to facilitating rapid treatment include the presence of cues to seek diagnosis in the patient's environment and the patient recognizing and acting upon these cues to seek immediate medical attention. Furthermore, providers who perform behaviors including recognizing cues as indicators of hematologic malignancies and conducting appropriate diagnostic testing effectively and efficiently indicate that these behaviors may also contribute to shorter times to diagnosis. In regards to referrals, direct and effective communication between providers and patients, as well between providers themselves helped facilitate speedier referrals. A patient's insurance status as well as the presence or absence of social support in his environment served as factors that may increase or decrease time to diagnosis, referral, and treatment for a hematologic malignancy. Further research is needed to define delay to diagnosis, referral and treatment in order to improve early diagnosis, referral, and treatment of hematologic malignancies.^

Malignant spinal cord compression: prospective study of delays in referral and treatment

Objectives: To examine the delay in presentation, diagnosis, and treatment of malignant spinal cord compression and to define the effect of this delay on motor and bladder function at the time of treatment.

A system for diagnosis, referral, and rehabilitation of persons convicted of driving while intoxicated: the system and a preliminary field test of the diagnostic procedure. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

A system for diagnosis, referral, and rehabilitation of persons convicted of driving while intoxicated: a special rehabilitation program for multiple offenders. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Wisconsin Alcohol Safety Action Project final report. Volume II - analytic studies. Part 5 - intake, diagnosis and referral of abusive drinker-drivers.

National Highway Traffic Safety Administration, Office of Alcohol Countermeasures, Washington, D.C.

First interim analysis of multiple offender treatment effectiveness. Interim report.

National Highway Traffic Safety Administration, Office of Driver and Pedestrian Programs, Washington, D.C.

First interim analysis of first offender treatment effectiveness. Interim report.

National Highway Traffic Safety Administration, Office of Driver and Pedestrian Programs, Washington, D.C.

An analysis of drinker diagnosis and referral activity. Analytic study 5.

National Highway Traffic Safety Administration, Washington, D.C.

Analysis of drinker diagnosis referral activity. Section II - volume 5. Final report.

National Highway Traffic Safety Administration, Office of Driver and Pedestrian Programs, Washington, D.C.

Treatment for the impaired driver. Volume II: case studies. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Treatment for the impaired driver. Volume I: approaches. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Diagnosis, referral, and rehabilitation within the Fairfax Alcohol Action Project, 1976 analytic study no. 5/6. Volume I.

National Highway Traffic Safety Administration, Office of Driver and Pedestrian Programs, Washington, D.C.

An analysis of driver diagnosis and referral activity. Final report.

Alcohol Safety Action Project--Puerto Rico, San Juan

An analysis of diagnosis, referral, rehabilitation and probation. Kansas City ASAP--analytic study 6. Final report.

National Highway Traffic Safety Administration, Washington, D.C.