Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients

Abstract

Background Performance measures for brief alcohol interventions (BIs) are currently based on provider documentation of BI. However, provider documentation may not be a reliable measure of whether or not patients are offered clinically meaningful BIs. In particular, BI documented with clinical decision support in an electronic medical record (EMR) could appear identical irrespective of the quality of BI provided. We hypothesized that differences in how BI was implemented across health systems could lead to differences in the proportion of documented BI recalled and reported by patients across health systems. Methods Male outpatients with unhealthy alcohol use identified by confidential satisfaction surveys (2009–2012) were assessed for whether they reported receiving BI in the past year (patient-reported BI) and whether they had BI documented in the EMR during the same period (documented BI). We evaluated and compared the prevalence of documented BI to patient-reported BI across 21 VA networks to determine whether documented BI had a variable association with patient-reported BI across the networks. Results Of 9896 eligible male outpatients with unhealthy alcohol use, 59.0% (95% CI 57.4–60.5%) reported BI (50.4–64.9% across networks) and 37.4% (95% CI 36.0–38.9%) had BI documented in the EMR (28.0–44.2% across networks). Overall, 72.9% (95% CI 70.8–75.5%) of patients with documented BI also reported BI. The association between documented BI and patient-reported BI did not vary across VA networks in adjusted logistic regression models. Conclusions Performance measures of BI that rely on provider documentation in EMRs appear comparable to patient report for comparing care across VA networks.

Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care: A national VA study

“…Brief intervention was measured based on text data that is generated when care is documented in response to an EHR clinical reminder (McGinnis et al, 2011). Consistent with our previous studies, (Bradley et al, 2013; Lapham et al, 2015; Williams et al, 2014) documentation of any advice to reduce and/or abstain from drinking in the 0–14 days following a positive screen was considered receipt of brief intervention. Advice to reduce and/or abstain from drinking is a key component of evidence-based brief intervention that is incentivized by the VA’s performance measure for brief intervention (Lapham et al, 2015; Whitlock et al, 2004).…”

Alcohol Screening and Intervention Among United States Adults who Attend Ambulatory Healthcare

“…47 Moreover, the validity of self-reported alcohol assessment is not known. The self-report of receipt of advice about drinking is comparable to documented advice in medical records and is used as a standard to evaluate the receipt of brief intervention in confidential surveys, 22,27 and healthcare visits and specialty treatment utilization can be recalled with good accuracy. 48,49 Alcohol problems may have only occurred after participants' healthcare visits.…”

“…Advice to reduce drinking is an important component of brief intervention. 7,22 The NSDUH also assessed specialty treatment or counseling for substance use. We considered respondents who said that they were treated for alcohol use only or for both alcohol and drugs in the past year to have obtained treatment or counseling.…”

Documented brief intervention not associated with resolution of unhealthy alcohol use one year later among VA patients living with HIV

“…Any documented brief intervention—the primary predictor variable—was defined as documentation of advice to reduce and/or abstain from drinking in the 0–14 days following a positive alcohol screen (Lapham et al, 2015). This component of VA’s performance measure for brief intervention is routinely documented using electronic clinical reminders, resulting in text data that can be extracted from the CDW to measure its receipt (Lapham et al, 2015; E.…”