Effectiveness of Brief Alcohol Counseling Implementation
Emily C. Williams PhD MPH
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: January 2012 - June 2013

BACKGROUND/RATIONALE:
Alcohol screening and brief alcohol counseling are considered the 3rd highest prevention priority for U.S. adults. Using a strategy of performance measures and electronic clinical reminders that allow for prompting and documenting care, the VA has accomplished very high rates of documented alcohol screening and brief alcohol counseling, distinguishing itself as an international leader in implementation. However, it is unknown whether VA patients are reaping the expected benefit of this program, which is decreased drinking. Research has shown variability in the quality of alcohol screening across facilities. It is likely that important facility-level variation in the quality of brief alcohol counseling exists and that variable implementation strategies will result in variable effectiveness across facilities. Therefore it is essential to understand how implementation differed at sites with more and less effective brief alcohol counseling.

OBJECTIVE(S):
Among outpatients who screen positive for alcohol misuse in Region 1 VA facilities, Aim 1 will test, overall and by facility, whether brief alcohol counseling documented with clinical reminders and incentivized by a performance measure is associated with resolution of alcohol misuse at follow-up screening. Aim 2 will develop and pilot-test a key-informant interview method at a single VA Medical Center to identify strategies used to implement brief alcohol counseling, as well as individual- and system-level needs of frontline adopters.

METHODS:
Aim 1 will use secondary data from the VA's Corporate Data Warehouse (CDW) and National Patient Care Database (NPCD). Among a cohort of VA patients who received care 1/1/04 - 12/31/08 in VA Region 1, Aim 1 analyses will include patients who: 1) screened positive for alcohol misuse (score 5) on an initial AUDIT-C administered after implementation of a brief alcohol counseling performance measure (10/1/07), and 2) had a subsequent documented AUDIT-C score at least 270 days later. Logistic regression, adjusted for potentially confounding covariates, will be used to estimate the proportion and 95% confidence interval of patients who resolve unhealthy alcohol use (AUDIT-C < 5 at follow-up with a difference of at least two points from baseline) among those with and without documented brief alcohol counseling, both overall and by facility. For Aim 2, we will develop and pilot-test a 30-minute, semi-structured key-informant interview at a single VA Medical Center and its affiliated clinics in the Pacific Northwest to identify implementation strategies for brief alcohol counseling. Interviews will be transcribed and analyzed using template analysis.

FINDINGS/RESULTS:
None to date.

IMPACT:
This study will determine whether patients with alcohol misuse in Region 1 with brief alcohol counseling documented with a clinical reminder are more likely to resolve alcohol misuse than those without and whether patients at some facilities appear to have greater responses to documented brief alcohol counseling than patients at others. Findings may help identify facilities that have implemented brief alcohol counseling more successfully than others. Refinement of the key informant interview strategy employed in Aim 2, in combination with findings from Aim 1, will provide a necessary foundation for a larger evaluation of the comparative effectiveness of different strategies for implementing alcohol counseling.

PUBLICATIONS:

Conference Presentations

1. Williams EC, Rubinsky AF, Lapham GT, Achtmeyer CE, Rittmueller S, Bradley KA. No Association between Documented Brief Intervention and Resolution of Alcohol Misuse in 30 VA Medical Centers. Poster session presented at: Addiction Health Services Research Conference; 2012 Oct 18; New York, NY.
2. Williams EC, Rubinsky AF, Lapham GT, Achtmeyer CE, Rittmueller S, Bradley KA. No Association between Documented Brief Intervention and Resolution of Alcohol Misuse in 30 VA Medical Centers. Poster session presented at: International Network on Brief Interventions for Alcohol Problems Annual Conference; 2012 Sep 28; Barcelona, Spain.

DRA: Substance Abuse and Addiction
DRE: none
Keywords: QUERI Implementation
MeSH Terms: none