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Drug Alcohol Depend. 2015 Aug 1;153:159-66. doi: 10.1016/j.drugalcdep.2015.05.027. Epub 2015 May 27.

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

Author information

1
Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States. Electronic address: lapham.g@ghc.org.
2
Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States. Electronic address: Anna.Rubinsky@va.gov.
3
Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States. Electronic address: shortreed.s@ghc.org.
4
Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: Eric.Hawkins@va.gov.
5
Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States. Electronic address: richards.je@ghc.org.
6
Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 Pacific Street, Seattle, WA 98195, United States. Electronic address: Emily.Williams@va.gov.
7
Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States; Primary and Specialty Medical Care Services, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States. Electronic address: Douglas.Berger@va.gov.
8
Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 Pacific Street, Seattle, WA 98195, United States. Electronic address: Laura.Chavez2@va.gov.
9
Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: Daniel.kivlahan@va.gov.
10
Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States; Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: bradley.k@ghc.org.

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.

KEYWORDS:

Brief alcohol intervention; Patient self-report; Performance measurement; Provider documentation

PMID:
26072218
PMCID:
PMC4620927
DOI:
10.1016/j.drugalcdep.2015.05.027
[Indexed for MEDLINE]
Free PMC Article

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