As аn expert in Heаlth Outcоmes аnd Implementatiоn Science, yоu are regularly asked to help other researchers choose the best design for their study. A team of investigators approaches you about studying whether their newly developed electronic health record (EHR) decision support tool increases screening and brief interventions for excessive alcohol use among adults attending primary care visits. The investigative team provides you with the following background information. Excessive alcohol use in adults 21 years of age includes binge drinking (drinking 5 drinks on an occasion for men or 4 drinks on an occasion for women), heavy drinking (drinking 15 drinks per week for men or 8 drinks per week for women) (Centers for Disease Control and Prevention 2024). In the United States, approximately 17% of adults binge drink and 7% report heavy drinking (Centers for Disease Control and Prevention 2024). In the United States, during 2020-2021, approximately 20,000 cancer deaths were attributable to alcohol use and 16,800 of these deaths could have been prevented if the adults who drank excessively reduced their alcohol use to 2 drinks/day for men or ≤1 drink/day for women (Esser et al. 2024). The US Preventive Services Task Force (2018) recommends that primary care providers screen for excessive alcohol use and provide brief behavioral counseling to persons who are engaging in excessive alcohol use. The International Classification of Diseases, Ninth and Tenth Revision (ICD-9/ICD-10) include diagnostic and procedure codes for brief alcohol interventions. The investigators’ EHR clinical decision support tool includes EHR prompts for screening for excessive alcohol use and initiating a brief intervention when patients screened positive for excessive alcohol use. The investigators include the medical director of Healthy People Clinics that has 30 primary care clinics for adults throughout the state of Florida. Their EHR director informs you that the EHR clinical decision support tool can be assigned to specific clinics and that in clinics who have the tool installed all physicians will see the tool with all patients. References: Centers for Disease Control and Prevention. Alcohol Use and Your Health [Internet]. U.S. Department of Health and Human Services; 2024 May [cited 2024 July 30]. Available from: https://www.cdc.gov/alcohol/about-alcohol-use/index.html#cdc_behavioral_basics_warning_signs-understanding-alcohol-use Centers for Disease Control and Prevention. Data on Excessive Drinking [Internet]. U.S. Department of Health and Human Services; 2024 May [cited 2024 July 30]. Available from: https://www.cdc.gov/alcohol/data-stats.htm#:~:text=Approximately%2017%25%20of%20adults%20binge,lost%20each%20year%2C%20on%20average. Esser MB, Sherk A, Liu Y, Henley SJ, Naimi TS. Reducing Alcohol Use to Prevent Cancer Deaths: Estimated Effects Among U.S. Adults. Am J Prev Med [Internet]. 2024 Apr; 66(4):725-729. doi: 10.1016/j.amepre.2023.12.003. - https://doi.org/10.1016/j.amepre.2023.12.003 US Preventive Services Task Force. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA [Internet]. 2018;320(18):1899–1909. doi:10.1001/jama.2018.16789 - https://jamanetwork.com/journals/jama/fullarticle/2714537 Using complete sentences and paragraph format, create a 1-page research proposal for the investigators. Be sure to include: A suggested hypothesis including the four criteria for a good hypothesis Based on what you know about the EHR clinical decision support tool and screening and brief interventions for excessive alcohol, what is the best type of study design to address your hypothesis. Explain your choice of study design by considering how each of the following affect the study design: what is the outcome of interest, who are the subjects, what is the exposure of interest, who assigned the exposure, and how is the exposure assigned. Explain how the study will be conducted: The main design elements (setting, participants) the outcome and exposure variables the data sources and how you will measure the outcome and exposure Based on your design and planned conduct of the study, describe two potential biases and how to measure or minimize them Make and explain any necessary assumptions. You are not expected to be an expert on alcohol use or EHR decision support tools. Your answer will be evaluated on the reasonableness and justification of your design.