Fetal alcohol spectrum disorders prevention and clinical guidelines

The public purpose of this award is to use the Military Health System (MHS) as a model for large health systems investigating the impact of Fetal Alcohol Spectrum Disorders (FASD) on families and the working age population including parents and prospective parents on factors such as resource allocation; burden of disease; quality and efficiency of care; access to care; and population-level health outcomes. This research will enable those who work in and around health systems to apply the innovative techniques and models developed and utilize findings to inform decision-making by leaders and providers not only in the MHS but other health systems nationwide and across other high-income countries.

FASD Strategic objectives

Research Objectives

  1. An environmental scan will be used to assess the external and internal environments of health programs and policies in the DoD, DHA, the MHS, and the Services related to alcohol use disorder, pre-pregnancy and pregnancy counseling, and early identification and diagnoses of children born at risk of FASD. This includes a comparative review of MHS focused Clinical Practice Guidelines against best practices across the FASD care continuum available in the Nation. Further, we will identify any systems-level barriers and facilitators to solving this complex health problem in the context of the military community.
  2. We will adopt the model of a community needs assessment to understand the lived experience of patients, caregivers, and diverse inter-professional providers in the Military Health System and the Department of Defense with respect to AU/AUD; pre-pregnancy counseling and prenatal care and education; and early identification, diagnosis, and care for children affected by FASD. We will identify supply- and demand-side facilitators and barriers (e.g. stigma) across the FASD care continuum to solving this complex health problem in the context of the military community.
  3. We will rigorously examine the population health outcomes and risk factors across the FASD continuum of care using modeling and predictive analytics in longitudinal MHS electronic health record data to generate lessons learned. Because MHS beneficiaries comprise a large (9.6 million), nationally-representative population, and because they can receive care in either the military or civilian setting through the TRICARE insurance benefit, findings from this study are expected to be generalizable to the greater U.S. population and to inform discussion for other large health systems.

Education and Training objectives

  • Create annual workshop opportunities for civilian and military partners and scientific leaders across the continuum of care for FASD.
  • Bring and annual FASD-themed focus to current efforts including the Health Services Research (HSR) Interest Group for over 100 military, civilian, and corporate members nationwide. This project will engage these stakeholders on the care continuum for FASD, as well as population-level outcomes.
  • Provide opportunities for civilian and military graduate students, doctoral candidates, and medical residents to investigate the system-level and population-level needs and effects of the FASD care continuum within a large health system, especially highly-relevant topics such as alcohol use and alcohol use disorder, maternal outcomes, and pediatric outcomes.

FASD Key Themes

  • Resource allocation
  • Cost, quality & efficiency of care
  • Access to care
  • Population-level health outcomes
  • Rates of alcohol use disorder among women with and without children
  • Identification of at-risk women and infants
  • Race-based disparities