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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1117 — A Majority of Brief Alcohol Interventions Documented in the Medical Record are Reported By VA Patients

Bradley KALapham GTChavez LJWilliams ECRubinsky AD, and Kivlahan DR, VA Puget Sound Healthcare System;

Objectives:
The VA Healthcare System implemented alcohol screening and brief interventions (BI), using national performance measures and electronic clinical reminders, making it easy for providers to click a box that documents BI. The objective of the present study was to determine how often patients who have BI documented in their medical records report receiving documented BI.

Methods:
This study included VA outpatients whose medical records were reviewed for a quality improvement program (7/2006-3/2009) conducted for the VA Office of Quality and Performance (OQP), and who had documented alcohol screening, and were mailed OQP’s outpatient survey in the following year. Documented BI was defined as alcohol-related feedback or advice to drink less or abstain documented in the medical record. We evaluated the proportion of patients who reported past-year receipt of BI from a VA provider on the survey across groups based on documented alcohol screening results and whether BI was documented. Logistic regression evaluated factors hypothesized to be associated with patient report of BI among screen-positive patients with documented BI.

Results:
Among 12,129 outpatients, 11,312 screened negative for alcohol misuse and 817 (6.7%; 95% CI 6.3-7.2%) screened positive, and 272 (33.3%; 95% CI 30.1-36.5%) of the latter group had BI documented. Among screen-positive patients with documented BI, 68% (95% CI 62.5-73.6%) reported receiving BI. Rates of patient-reported BI were 45.5% (95% CI 41.3-49.7%) among screen-positive patients without documented BI, and 9.9% (95% CI 9.4-10.5%) among screen-negative patients. None of the hypothesized factors were associated with report of alcohol-related advice on the survey including gender, age, race, time before or after the performance measure, whether alcohol-related advice was explicitly documented in medical records, or the time from screening to the survey.

Implications:
About two-thirds of patients who screen positive for alcohol misuse and have BI documented reported having received BI, although 32% did not.

Impacts:
Patient report of BI on surveys is limited for the most part to those who have had documented positive alcohol screens. Additional research is needed to determine whether documented BI and/or patient reported BI are associated with resolution of alcohol misuse and improved health outcomes.


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