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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3140 — Increases in the Prevalence of Patient-Reported Alcohol-Related Advice Following Performance Measure Implementation

Chavez LJLapham GTWilliams EC, and Bradley KA, VA Puget Sound Healthcare System;

Alcohol screening and brief interventions (BI) are ranked the 3rd highest prevention priority. The Veterans Affairs (VA) Health Care System has dedicated significant resources to BI implementation, including implementation of a performance measure (PM) for BI and clinical reminder (CR). Rates of documented BI or referral have increased to 76% over the past 5 years. The objective of this study was to evaluate whether patient report of BI among patients who screened positive for alcohol misuse also increased during this period.

This cross-sectional study used data from the VA’s Office of Quality and Performance’s (OQP) Survey of Healthcare Experiences of Patients (SHEP), which randomly samples VA outpatients with a past-month visit. SHEP respondents (October 2006-September 2010) who screened positive for alcohol misuse (AUDIT-C >=5), and answered a question about past-year receipt of alcohol-related advice from a VA provider (patient-reported BI) were included (N = 59,567). Respondents were assigned to 1 of 5 time periods based on when their outpatient visit occurred: a baseline period, during implementation of the PM and CR, and 3 follow-up periods. Logistic regression models were used to estimate the prevalence of patient-reported BI over these periods. Analyses were clustered on medical facility and adjusted for age, race, gender, education, smoking status, and alcohol misuse severity.

The adjusted prevalence of BI increased significantly from 39.4% (95% CI 38.4%-40.9%) in the baseline period to 58.9% (95% CI 56.2%-61.5%) in the final follow-up period, with increased prevalence across all periods (test for trend, p <0.001).

Combined with the known increases in provider documentation of BI, increases in patient-reported BI in the present study further support VA’s successful integration of alcohol-related care into routine practice.

Patient reports that demonstrate recall of receiving evidence-based care may better reflect the quality of interventions and their potential impact on health behaviors than measures relying on documentation of care. Despite increased report of BI, nearly 40% of patients who screened positive for alcohol misuse did not report receiving BI. More research is needed to determine ways to further improve the quality and delivery of BI so that patients who could benefit from this care recall receiving it.

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