The goal of the Disseminating Organizational Screening and Brief Interventions Services
(DO-SBIS) investigation is to capitalize on the unique opportunity afforded by the American
College of Surgeons' mandate by taking early steps to insure high quality, evidence-based
SBI services are implemented and outcomes are assessed. In the first phase of the
investigation, SBI services will be assessed for all 190 level I trauma centers in the
United States. In the second phase of the investigation, 20 level I trauma centers will be
selected for randomization to intervention or control conditions.
Each year in the United States approximately 2.5 million individuals are so severely injured
that they require inpatient hospital admission. The integration of screening and brief
interventions (SBI) into acute injury care has the potential to markedly increase the number
of patients who receive needed services and has been a longstanding public health objective.
In January of 2005 the American College of Surgeons, the primary agency responsible for
developing trauma center requirements, passed a landmark resolution mandating that level I
trauma centers must screen injured patients for an alcohol use disorder, and provide an
intervention to those who screen positive. Preliminary studies suggest that there is a
substantial risk that the SBI mandate will be implemented with marked variability and that
low quality SBI procedures could become the default standard of trauma center care.
Providers at each intervention trauma center will receive workshop training and ongoing
telephone coaching in the delivery of evidence-based motivational interviewing (MI)
intervention; MI training will be embedded within evidence-based organizational development
activities that aim to facilitate the integration of SBI services into routine trauma center
care. Control trauma centers will implement SBI care as usual. The investigation
hypothesizes that intervention trauma centers, when compared to control trauma centers, will
demonstrate higher quality SBI, as evidenced by greater provider proficiency in SBI
delivery, significant reductions in 6- and 12-month post-injury alcohol use in patients
receiving SBI, and enhanced organizational acceptance of SBI services. Without DO-SBIS
baseline data on SBI services and follow-up RCT data on patient, provider, and
organizational outcomes, a critical opportunity to provide empiric support of a historic
policy decision to require alcohol services at level I trauma centers could be lost. The
DO-SBIS interdisciplinary research group includes trauma surgery opinion leaders who are
dedicated to implementing future policy mandates that derive from the DO-SBIS research
program. Future mandates will aim to strengthen and refine trauma center delivery of
evidence-based SBI services. The dissemination of high quality SBI services at level I
trauma centers has the potential to influence alcohol policy in other health care settings
- For provider subjects: staff at trauma centers selected by study
- For patient subjects: admitted to trauma centers selected by study, positive blood
alcohol levels, able to provide two follow-up contacts
- For Providers: Once a trauma center is selected for participation, providers will be
selected from existing hospital staff.
- For Patients: Patients so severely injured that they cannot participate in study
procedures will be excluded;
- Patients who are admitted after self-inflicted injury, or are psychotic and therefore
require more intensive acute interventions, will not be included in the study;
- Injured hospitalized prisoners are excluded.
- Children under the age of 18 are excluded.