Substance Abuse Clinical Trial
Official title:
Substance Treatment Referral System
The lack of substance screening and referral in healthcare settings is a significant problem
with far-reaching consequences, including excess morbidity, premature mortality, and inflated
healthcare costs. An easy to use, time-efficient referral system is needed to address this
problem. The Substance Treatment Referral Systems (STaRS), a computer assisted screening and
referral system, was developed to meet this need.
STaRS Phase I demonstrated the feasibility of STaRS to meet this need. All aims and
evaluation goals of the Phase I study were met or exceeded. The purpose of the Phase II
research is to demonstrate the clinical utility and commercial viability of STaRS.
Specific Aims of Phase II are:
1. Integrate STaRS with the Epic electronic health record used in the Cooper Health System
in Camden, N.J.
2. Document STaRS' effectiveness in (a) increasing the number of referrals provided for
substance abuse treatment and HIV screening, and (b) increasing the proportion of
patients that initiate specialty treatment.
3. Evaluate clinician acceptance and impact upon revenue generation.
The research will be conducted at Cooper Family Medicine (CFM) department of Cooper
University Hospital in New Jersey. We will determine the rate of referrals and treatment
initiation for 3,500 adult patients treated during treatment as usual (the time before STaRS
is implemented at CFM) as well as 3,500 adult patients treated after the introduction of
STaRS. Patients will be asked about the referral initiation process, and CFM healthcare
providers will be asked to evaluate the system from a clinical and administrative
prospective. Finally, billing records will be reviewed during the STaRS implementation to
determine whether STaRS impacted revenue for the practices.
STaRS is a computer assisted screening and referral system for problem substance use,
designed for use in medical settings. The primary function of STaRS is to facilitate
physician referrals for tobacco, alcohol, other drugs, and HIV screening, tailored to the
patient's condition and circumstances (e.g., zip code and insurance).
A prototype of STaRS was developed and found to be feasible in medical settings in Phase I.
Phase II research will demonstrate clinical utility and commercial viability of the system in
a medical setting (e.g., Cooper University Hospital Family Medicine practices). Prior to
beginning the Phase II research, focus groups were conducted to refine changes to the STaRS
software. These focus groups consisted of healthcare providers from Cooper Family Medicine
(CFM) practices.
The Phase II research will be conducted in several parts, described in the following
sub-studies, conducted simultaneously:
1. Referral Sub-Study. To determine the impact of STaRS on the rate of referral for
substance abuse treatment and HIV screening, 7,000 adult patients' charts will be
reviewed (3,500 patients seen prior to STaRs implementation and 3,500 patients seen
after STaRS implementation).
2. Treatment Initiation Sub-Study. To test the effectiveness of STaRS on treatment
initiation, 140 patients who receive referrals during the STaRS implementation will be
telephoned by research staff and invited to participate in this sub-study to document
treatment initiation. Treatment initiation refers to whether the patient has made
contact or scheduled an appointment with the referral provider.
3. Billing and Revenue Generation Sub-Study. Seven thousand medical records will be
reviewed for the referral study (described above). Patients who were given referrals for
substance use and HIV screening will have their billing records reviewed by the Cooper
Research Assistant (RA). The goal is to determine the amount billed for the session in
which the referral was made and the amount paid by the insurer (or Medicaid, Medicare).
This data will be used to determine the effectiveness of STaRS to increase revenues for
the practices.
4. Provider Evaluation of STaRS Sub-Study. At the conclusion of the study, focus groups
will be conducted with the CFM healthcare providers. The focus groups will have 3 goals:
Rating the STaRS system on ease of use and clinical utility; soliciting suggestions
regarding enhancements to STaRS and procedures to implementation and training; and
identifying any factors that may have influenced the providers to screen or refer
patients.
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