title: Increased documented brief alcohol interventions with a performance measure and electronic decision support.
abstract: BACKGROUND
  Alcohol screening and brief interventions (BIs) are ranked the third highest US prevention priority, but effective methods of implementing BI into routine care have not been described.
  
  
  OBJECTIVE
  This study evaluated the prevalence of documented BI among Veterans Affairs (VA) outpatients with alcohol misuse before, during, and after implementation of a national performance measure (PM) linked to incentives and dissemination of an electronic clinical reminder (CR) for BI.
  
  
  METHODS
  VA outpatients were included in this study if they were randomly sampled for national medical record reviews and screened positive for alcohol misuse (Alcohol Use Disorders Identification Test-Consumption score ≥5) between July 2006 and September 2008 (N=6788). Consistent with the PM, BI was defined as documented advice to reduce or abstain from drinking plus feedback linking drinking to health. The prevalence of BI was evaluated among outpatients who screened positive for alcohol misuse during 4 successive phases of BI implementation: baseline year (n=3504), after announcement (n=753) and implementation (n=697) of the PM, and after CR dissemination (n=1834), unadjusted and adjusted for patient characteristics.
  
  
  RESULTS
  Among patients with alcohol misuse, the adjusted prevalence of BI increased significantly over successive phases of BI implementation, from 5.5% (95% CI 4.1%-7.5%), 7.6% (5.6%-10.3%), 19.1% (15.4%-23.7%), to 29.0% (25.0%-33.4%) during the baseline year, after PM announcement, PM implementation, and CR dissemination, respectively (test for trend P<0.001).
  
  
  CONCLUSIONS
  A national PM supported by dissemination of an electronic CR for BI was associated with meaningful increases in the prevalence of documented brief alcohol interventions.
authors.affiliation: Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA 98101, USA. Gwendolyn.Lapham@va.gov
authors.forename: Gwen T
authors.initials: GT
authors.lastname: Lapham
authors.forename: Carol E
authors.initials: CE
authors.lastname: Achtmeyer
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hawkins
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D003376:Counseling; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D017010:Reminder Systems; D014481:United States; D014493:United States Department of Veterans Affairs