Application of system dynamics modeling to inform implementation of adolescent SBIRT in primary care settings

摘要

We apply system dynamics (SD) modeling to better understand the influence of different implementation strategies on the effective implementation of screening and brief intervention. Using qualitative and quantitative data from an on-going cluster randomized trial in 8 federally qualified health center sites, two implementation conditions were compared: Generalist vs. Specialist. In the Generalist Approach, the primary care provider (PCP) delivers brief intervention (BI) for substance misuse (n=4 clinics). In the Specialist Approach, BIs are delivered by behavioral health counselors (BHCs) (n=4 clinics). We used our SD model to compare 'basecase' dynamics to strategic approaches to deploying Continuous Technical Assistance (TA) and Performance Feedback Reporting (PFR). We calibrated our basecase to effectively represent the SBIRT intervention, which reflected actual monthly volume of adolescent primary care visits (N=9,639), screenings (N=5,937), positive screenings (N=246), and brief interventions (BIs; N=50) over the 20-month implementation period. Insights gained suggest that implementation outcomes are sensitive to frequency of PFR, with bimonthly events generating the most rapid and sustained screening results. Simulated trends indicate that availability of the BHC directly impacts success of the Specialist model. Similarly, understanding PCPs' perception of severity of need for intervention is key to outcomes in either condition.