title: Probability and predictors of patients converting from negative to positive screens for alcohol misuse.
abstract: BACKGROUND
  Medicare reimburses providers for annual alcohol screening. However, the benefit of rescreening patients a year after a negative screen for alcohol misuse is unknown. We hypothesized that some subgroups of patients who screen negative would have a very low probability of converting to a positive subsequent screen (e.g., <0.1%), calling into question the value of annual alcohol screening for some patient subgroups.
  
  
  METHODS
  This retrospective cohort study estimated the probability of converting to a positive screen for alcohol misuse a year after a negative screen among outpatients from 30 Veterans Health Administration (VA) medical centers. Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) alcohol screening scores (range 0 to 12 points) from 2004 to 2008 were obtained from electronic health record data. Eligible patients screened negative on their initial screen (AUDIT-C scores 0 to 3 for men; 0 to 2 for women). The main outcome was a positive subsequent screen (AUDIT-C scores ≥4 men; ≥3 women).
  
  
  RESULTS
  Among 21,081 women and 323,913 men who screened negative on an initial screen, 5.4% and 6.0%, respectively, screened positive a year later. The adjusted probability of converting to a positive subsequent screen varied from 2.1 to 38.9% depending on age, gender, and initial negative screen score. Women, older patients, and those with initial AUDIT-C scores of 0 were least likely to a convert to a positive subsequent screen, while younger men with AUDIT-C scores of 3 were most likely to a convert to a positive subsequent screen.
  
  
  CONCLUSIONS
  The probability of a positive subsequent screen varied depending on age, gender, and initial negative screen score but exceeded 2% in all patient subgroups. Annual rescreening appears reasonable for all VA patients who had a negative screen the year prior.
authors.affiliation: Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington; Group Health Research Institute, Seattle, Washington.
authors.forename: Gwen T
authors.initials: GT
authors.lastname: Lapham
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.forename: Carol
authors.initials: C
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: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.forename: David
authors.initials: D
authors.lastname: Au
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000175:diagnosis*; D015331:Cohort Studies; D005006:Ethnicity; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Alcoholism and Addictive Behaviors; Decision Making; Screening