PROJECT SUMMARY/ ABSTRACT
The long-term goal of this K01 Mentored Research Scientist Development Award is to advance Dr. Shannon
Smith-Bernardin's development as an independent clinician-investigator focusing on novel treatment
paradigms for people with alcohol-use disorders and acute alcohol intoxication. This proposed project has four
training aims: advanced training in: 1) implementation science; 2) obtaining, merging and analyzing
administrative data; 3) qualitative and mixed-methods research; and 4) grant writing. Dr. Smith-
Bernardin has assembled a multi-disciplinary mentorship team including nationally recognized experts in
implementation science, emergency medicine, alcohol use disorders, vulnerable populations, frequent utilizers
of health care, mixed methods, and qualitative research. Alcohol use disorders are associated with significant
morbidity and mortality worldwide. In the United States, emergency departments (EDs) and the ambulance
system (EMS) provide the majority of acute care for alcohol intoxication. Between 2-12% of patients in medical
or psychiatric EDs are acutely intoxicated. “Sobering centers” were designed to address the needs of people
with acute uncomplicated alcohol intoxication who do not require ED care, so that these individuals could
receive safe, high value care in an alternative care setting. If used appropriately, sobering centers can reduce
the need for ED visits and reduce ED overcrowding. In Aim 1, Dr. Smith-Bernardin will characterize and define
the incidence of patients with acute alcohol intoxication in the Sobering Center, the ED, and EMS system and
compare the patient, provider, and environmental-level factors that influence the transport decision using
administrative data. In Aim 2, using the CFIR framework, she will conduct and analyze in-depth interviews to
determine modifiable factors influencing ambulance personnel's decision to transport patients with acute
uncomplicated alcohol intoxication to an ED instead of the Sobering Center. The proposed study is the first to:
1) evaluate paramedic decision making in a community with an established sobering center alternative; and 2)
recruit ambulance, ED, and Sobering Center personnel to examine the factors affecting triage in the field for
uncomplicated alcohol intoxication. Both aims will use innovative implementation science methods to
triangulate health related data from EMS, EDs, and the San Francisco Sobering Center. The training and
research conducted in the proposed project will form the basis of a future R01-proposal hybrid type II trial to
test the implementation and effectiveness of an intervention to reduce provider and environmental level
variation in order to increase of appropriate use of sobering centers and reduce reliance on the ED for acute
alcohol intoxication. The proposed project will provide Dr. Smith-Bernardin the support necessary to become
an independent clinician-scientist using implementation science and mixed-methods research to develop,
evaluate, and disseminate innovative, evidence-based treatment paradigms for individuals with alcohol-use
disorders and acute alcohol intoxication.
