title: Variation in documented care for unhealthy alcohol consumption across race/ethnicity in the Department of Veterans Affairs Healthcare System.
abstract: BACKGROUND
  The VA Healthcare System has made progress implementing evidence-based care for unhealthy alcohol use, but whether there are differences in care across race/ethnicity is unclear. We describe alcohol-related care for 3 racial/ethnic groups among VA outpatients with unhealthy alcohol use.
  
  
  METHODS
  This cross-sectional study utilized secondary quality improvement data collected for the VA Office of Quality and Performance (July 2006 to June 2007) to identify a sample of 9,194 black (n = 1,436), Hispanic (n = 500), and white (n = 7,258) VA outpatients who screened positive for unhealthy alcohol use (AUDIT-C score ≥4 men; ≥3 women). Alcohol-related care was defined as medical record documentation of brief intervention (advice or feedback) and/or referral (discussion of or scheduled). Logistic regression models estimated the prevalence of alcohol-related care among black, Hispanic, and white patients after adjustment for sociodemographic characteristics, alcohol use severity, other substance use, and mental health comorbidity.
  
  
  RESULTS
  Among all eligible patients, 2,903 (32%) had documented alcohol-related care. Adjusted prevalences were 35.3% (95% CI 30.0 to 40.5) for black, 27.3% (95% CI 21.1 to 33.5) for Hispanic, and 28.9% (95% CI 25.5 to 32.3) for white patients. Differences in documented alcohol-related care between all racial/ethnic groups were significant (p-values all < 0.05).
  
  
  CONCLUSIONS
  Among VA patients with unhealthy alcohol use, black patients had the highest, and Hispanic the lowest, prevalence of documented alcohol-related care. Future research should evaluate contextual and system-, provider-, or patient-level factors that may attenuate racial/ethnic differences in documented alcohol-related care, as well as whether differences in documented care are associated with differences in outcomes.
authors.affiliation: Health Services Research & Development, Seattle, Washington 98101, USA. emily.williams3@va.gov
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Gwen T
authors.initials: GT
authors.lastname: Lapham
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hawkins
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.forename: Leo S
authors.initials: LS
authors.lastname: Morales
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology* / Q000628:therapy*; D044383:Black People; D003430:Cross-Sectional Studies; D004282:Documentation; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D020380:Needs Assessment; D012017:Referral and Consultation; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans; D044465:White People; D001741:Black or African American