BACKGROUND/RATIONALE:
Implementation of brief alcohol counseling (BAC), including referral when appropriate, for patients with alcohol misuse is widely recognized as an important US and VA prevention priority. Unlike other health care systems worldwide that have been unable to implement BAC, VA has successfully implemented routine alcohol screening and is the process of implementing BAC as part of routine care.
OBJECTIVE(S):
The objectives of this project are 1) to evaluate the Office of Quality and Performance’s (OQP) current options for monitoring performance of BAC and 2) to evaluate the quality of BAC documented with a clinical reminder (CR). For the first aim, we will evaluate and recommend improvements to performance indicators for BAC based on medical record reviews, patient surveys and administrative data and describe the results of BAC indicators in OEF/OIF veterans and other subgroups (gender, age, race/ethnicity). For the second aim, we will use detailed CR tracking data from VISTA to clarify whether the CR for BAC was used for elements of BAC, risk-stratification, assessment of severity, and decision support, aside from documentation. We will also conduct preparatory work for a study using simulated patients (SP) in order to evaluate the quality of BAC in the VA.
METHODS:
To evaluate methods for monitoring performance of BAC, this study will use secondary, quality improvement data from two separate national samples of patients included in the VA’s External Peer Review Program (EPRP) and its ongoing Survey of Health Experiences of Patients (SHEP). These datasets will both be merged with the National Patient Care Databases (NPCD) to supplement and compare substance use disorder diagnoses and visits for alcohol misuse. Prevalence of BAC in EPRP and SHEP will be compared across both samples and in smaller of subset patients sampled by both. Rates of BAC or referral for alcohol misuse will be evaluated across subgroups (OEF/OIF, gender, age, etc.) and VISNs. To evaluate the quality of BAC documented with a CR, we will utilize already extracted VISTA datasets with patient-level data from VA Puget Sound and N. California, where we have piloted the CR. These data include specific patient-level CR activity documented by providers that have been electronically tagged and extracted. These datasets will be used to evaluate the proportion of patients whose providers documented 1) assessment of alcohol misuse severity using decision support tools in the CR (DSM-IV criteria for alcohol use disorders, laboratory markers, or the full AUDIT questionnaire); 2) feedback linking alcohol use to health; or 3) more intense interventions for those with severe misuse (e.g. referral) reflecting embedded risk-stratification algorithm. We will also conduct pilot work for a study using SP’s to evaluate the quality of BAC by demonstrating the feasibility of an SP study at our local VAMC and developing two SP roles.
FINDINGS/RESULTS:
None at this time
IMPACT:
This study will provide important information on the effectiveness of several performance indicators for monitoring BAC and on the quality of BAC documented with a clinical reminder. Results from this study will be used to develop policy recommendations for national implementation of BAC performance measures for positive alcohol screens. This study will also provide essential information on the feasibility of an SP study in the VA.
PUBLICATIONS:
Journal Articles
- Hawkins EJ, Kivlahan DR, Williams EC, Wright SM, Craig T, Bradley KA. Examining quality issues in alcohol misuse screening. Substance Abuse. 2007; 28(3): 53-65.
- Bradley KA, Williams EC, Achtmeyer CE, Hawkins EJ, Harris AH, Frey MS, Craig T, Kivlahan DR. Measuring performance of brief alcohol counseling in medical settings:a review of the options and lessons from the Veterans Affairs (VA) health care system. Substance Abuse. 2007; 28(4): 133-49.
