title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. Electronic address: Litzy.wu@duke.edu.
authors.forename: Li-Tzy
authors.initials: LT
authors.lastname: Wu
authors.affiliation: South Carolina Clinical and Translational Research Institute, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Brady
authors.affiliation: Division of Endocrinology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Spratt
authors.affiliation: Duke Translational Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Dunham
authors.affiliation: Duke Translational Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Brooke
authors.initials: B
authors.lastname: Heidenfelder
authors.affiliation: Division of Endocrinology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Batch
authors.affiliation: The EMMES Corporation, Rockville, MD, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Lindblad
authors.affiliation: The EMMES Corporation, Rockville, MD, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: VanVeldhuisen
authors.affiliation: Duke Translational Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Rusincovitch
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Therese K
authors.initials: TK
authors.lastname: Killeen
authors.affiliation: National Institute on Drug Abuse, Bethesda, MD, USA.
authors.forename: Udi E
authors.initials: UE
authors.lastname: Ghitza
mesh_terms: D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D057286:Electronic Health Records; D005240:Feasibility Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009657:North Carolina / Q000453:epidemiology; D058991:Patient Protection and Affordable Care Act; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy
keywords: Diabetes; Home-based primary care; Medical comorbidity; Referral to treatment; Substance use disorder; Substance use screening