Study Shows VA’s Brief Alcohol Intervention Strategy Successful
FINDINGS:
- VA’s strategy of implementing brief alcohol interventions with a performance measure supported by a clinical reminder meaningfully increased documentation of brief interventions over a one-year period.
- Among Veteran outpatients with alcohol misuse, the prevalence for brief interventions increased significantly over successive phases of implementation – from 5.5% at baseline – to 7.6% after announcement of the brief intervention performance measure – to 19.1% following implementation of the measure – to 29% following dissemination of the clinical reminder.
- Brief interventions increased among patients without prior alcohol use disorders or addictions treatment, as well as those with recognized drinking problems, with proportionately greater increases among the former group after clinical reminder dissemination.
BACKGROUND:
Alcohol misuse is a significant cause of disease and disability, accounting for nearly 4% of deaths worldwide. Alcohol screening and brief alcohol interventions are ranked the third highest U.S. prevention priority, but effective methods of implementing brief interventions into routine care have not been described. Over the past five years, VA has taken a stepped approach to implementing alcohol screening and brief interventions with performance measures and clinical reminders in the electronic medical record. This retrospective study evaluated the prevalence of documented brief interventions among VA outpatients with alcohol misuse before, during, and after implementation of a national performance measure linked to incentives and dissemination of an electronic clinical reminder for brief interventions. Using data from VA’s Office of Quality and Performance (OQP) External Peer Review Program (EPRP), investigators examined documented brief interventions among 6,788 VA outpatients who screened positive for alcohol misuse between 7/06 and 9/08. Outcome measures for this study included documentation of advice and/or feedback related to alcohol use within 30 days of alcohol screening.
LIMITATIONS:
- The length of each phase of brief intervention implementation varied from three months to one year, and the shorter intervals may not have allowed sufficient time to measure any impact of the implementation phase on the prevalence of documented brief interventions.
- This study lacked the power to evaluate other potentially important moderators (e.g., gender, age).
AUTHOR/FUNDING INFORMATION:
This study was funded through VA/HSR&D’s Substance Use Disorders Quality Enhancement Research Initiative (SUD-QUERI). Several authors are part of SUD-QUERI.
Lapham G, Achtmeyer C, Williams E, et al. Increased Documented Brief Alcohol Interventions with a Performance Measure and Electronic Decision Support. Medical Care September 28, 2010;e-pub ahead of print.
