Measuring Performance of Brief Alcohol Counseling in Medical Settings

Bradley, Katharine A.; Williams, Emily C.; Achtmeyer, Carol E.; Hawkins, Eric J.; Harris, Alex H. S.; Frey, Madeleine S.; Craig, Thomas J.; Kivlahan, Daniel R.

doi:10.1300/j465v28n04_05

Cited by 32 publications

(16 citation statements)

References 65 publications

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“…Alcohol consumption is related to increased risks of postoperative morbidity and mortality [23, 24]. Alcohol cessation or a reduction in consumption four weeks prior to surgery is effective in reducing the risk of developing postoperative complications.…”

Section: Before the Day Of Surgerymentioning

confidence: 99%

The Prevention of Periprosthetic Joint Infections

Küçükdurmaz

Parvızı

2016

TOORTHJ

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Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

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Section: Before the Day Of Surgerymentioning

confidence: 99%

The Prevention of Periprosthetic Joint Infections

Küçükdurmaz

Parvızı

2016

TOORTHJ

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“…However, the proportion of patients with moderate to severe misuse who reported alcohol-related advice did not increase in the first 4 years of screening alone, before brief interventions were implemented. In 2004, when screening was introduced, the rate was 40%-the same as that in 2007 (Bradley et al, 2007b). This suggests that increases in patient-reported alcohol-related advice may be attributable to brief interventions implementation rather than screening itself.…”

Section: Discussionmentioning

confidence: 93%

“…alcohol-related advice among patients who screened positive for alcohol misuse increased from 40.4% to 56.7% and remained stable at 55.5% in FY 2011. The adjusted difference in rates of patient-reported alcohol-related advice was greater for patients with positive screens for moderate to severe alcohol misuse (AUDIT-C scores 5-12) who were targeted by the VA's performance measure for brief interventions compared with those with lower AUDIT-C scores who were not expected to be offered brief interventions (Bradley et al, 2007b). These findings further suggest that the observed increases in rates of patient-reported alcoholrelated advice may be related to the VA's efforts to implement brief interventions.…”

Section: Discussionmentioning

confidence: 97%

“…An early evaluation showed that alcohol screening alone did not increase rates of brief interventions (Bradley et al, 2006(Bradley et al, , 2007b, so a performance measure for brief interventions linked to financial incentives for health system leaders was implemented in 2008. The performance measure required clinicians to document two core elements of brief interventions for patients who screen positive for alcohol misuse: advice to drink below recommended limits and feedback linking drinking to health (Lapham et al, 2012;Whitlock et al, 2004).…”

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confidence: 99%

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Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions

Chavez

Williams

Lapham

et al. 2016

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Brief alcohol interventions are recommended for primary care patients who screen positive for alcohol misuse, but implementation is challenging. The U.S. Veterans Health Administration (Veterans Affairs [VA]) implemented brief interventions for patients with alcohol misuse in 2008, and rates of brief interventions documented in the electronic medical record increased from 24% to 78% (2008-2011). This study examined whether an independent measure of brief interventions-patient-reported alcohol-related advice-also increased among VA outpatients who screened positive for alcohol misuse on a mailed survey. Method: This retrospective cross-sectional study included VA outpatient respondents to the VA's Survey of Healthcare Experiences of Patients (SHEP;-2011 who reported past-year alcohol use and answered a question about alcohol-related advice. Alcohol-related advice was defined as a report of past-year advice from a VA clinician to abstain from or reduce drinking. The adjusted prevalence of alcoholrelated advice among patients who screened positive for alcohol misuse (SHEP AUDIT-C 5) was estimated for each year. Results: Among patients with alcohol misuse (n = 61,843), the adjusted prevalence of alcohol-related advice increased from 40.4% (95% CI [39.3%, 41.5%]) in 2007 to 55.5% (95% CI [53.3%, 57.8%]) in 2011. Rates of alcoholrelated advice increased significantly each year except the last. Conclusions: The VA's efforts to implement brief interventions were associated with increased patient-reported alcohol-related advice over time, with a majority of patients with alcohol misuse reporting its receipt. Other systems considering similar approaches to implementation may benefit from collecting patient-reported measures of brief interventions for an additional perspective on implementation. (J. Stud. Alcohol Drugs, 77, 500-508, 2016)

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“…“denominator bias”) is to require use of a specific validated screening questionnaire and threshold to standardize the denominator. (13) This strategy is used by the Veterans Health Administration (VA) for alcohol misuse as well as depression and post-traumatic stress disorder (PTSD). (11,14) However, recent research has demonstrated that despite use of a uniform screening questionnaire and threshold for a positive screen, the sensitivity of alcohol screening programs may vary across VA networks,(15) likely due to differences in how screening is implemented in practice, e.g.…”

Section: Introductionmentioning

confidence: 99%

When Quality Indicators Undermine Quality: Bias in a Quality Indicator of Follow-Up for Alcohol Misuse

Bradley¹,

Chavez²,

Lapham³

et al. 2013

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Background Valid quality indicators are needed to monitor and incentivize identification and management of mental health and substance use conditions (“behavioral conditions”). Because behavioral conditions are frequently under-identified, quality indicators often evaluate the proportion of patients who screen positive for a condition who have appropriate follow-up care documented. However, these “positive-screen-based” quality indicators of follow-up for behavioral conditions could be biased by differences in the denominator due to differential screening quality (“denominator bias”) and could reward identification of fewer patients with the behavioral condition(s) of interest. Objective To evaluate denominator bias in the performance of Veterans Health Administration (VA) networks on a quality indicator of follow-up for alcohol misuse that used patients with positive alcohol screens as the denominator. Methods The performance of 21 VA networks on a positive-screen-based quality indicator of follow-up for alcohol misuse was compared to the networks' performance on a population-based quality indicator (proportion of eligible patients who had alcohol misuse identified and follow-up documented) using medical record reviews (n=219,119). Results Results of the two quality indicators were inconsistent. For example, two networks performed similarly on the quality indicators (64.7%, 65.4%) even though one identified and documented follow-up for almost twice as many patients (5,411 and 2,899 per 100,000 eligible, respectively). Networks that performed better on the positive-screen-based quality indicator identified fewer patients with alcohol misuse than networks that performed better on the population-based quality indicator (mean 4.1% vs 7.4% respectively). Conclusion A positive-screen-based quality indicator of follow-up for alcohol misuse preferentially rewarded networks that identified fewer patients with alcohol misuse.

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Measuring Performance of Brief Alcohol Counseling in Medical Settings

Cited by 32 publications

References 65 publications

The Prevention of Periprosthetic Joint Infections

The Prevention of Periprosthetic Joint Infections

Changes in Patient-Reported Alcohol-Related Advice Following Veterans Health Administration Implementation of Brief Alcohol Interventions

When Quality Indicators Undermine Quality: Bias in a Quality Indicator of Follow-Up for Alcohol Misuse

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