Disseminating alcohol screening and brief intervention at trauma centers: a policy-relevant cluster randomized effectiveness trial.
OBJECTIVE
In 2005 the American College of Surgeons passed a mandate requiring that level I trauma centers have mechanisms to identify and intervene with problem drinkers. The aim of this investigation was to determine if a multi-level trauma center intervention targeting both providers and patients would lead to higher-quality alcohol screening and brief intervention (SBI) when compared with trauma center mandate compliance without implementation enhancements.


METHODS
Cluster randomized trial in which intervention site (site n = 10, patient n = 409) providers received 1-day workshop training on evidence-based motivational interviewing (MI) alcohol interventions and four 30-minute feedback and coaching sessions; control sites (site n = 10, patient n = 469) implemented the mandate without study team training enhancements.


METHODS
Trauma centers in the United States of America.


METHODS
A total of 878 blood alcohol-positive in-patients with and without traumatic brain injury (TBI).


METHODS
MI skills of providers were assessed with fidelity coded standardized patient interviews. All patients were interviewed at baseline and 6- and 12-months post-injury with the Alcohol Use Disorders Identification Test (AUDIT).


RESULTS
Intervention site providers consistently demonstrated enhanced MI skills compared with control providers. Intervention patients demonstrated an 8% reduction in AUDIT hazardous drinking relative to controls over the course of the year after injury (relative risk = 0.88, 95%, confidence interval = 0.79, 0.98). Intervention patients were more likely to demonstrate improvements in alcohol use problems in the absence of traumatic brain injury (TBI) (P = 0.002).


CONCLUSIONS
Trauma center providers can be trained to deliver higher-quality alcohol screening and brief intervention (SBI) than untrained providers, which is associated with modest reductions in alcohol use problems, particularly among patients without TBI.
Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA.
Douglas
D
Zatzick
Dennis M
DM
Donovan
Gregory
G
Jurkovich
Larry
L
Gentilello
Chris
C
Dunn
Joan
J
Russo
Jin
J
Wang
Christopher D
CD
Zatzick
Jeff
J
Love
Collin
C
McFadden
Frederick P
FP
Rivara
D000328:Adult; D019973:Alcohol-Related Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D001930:Brain Injuries / Q000150:complications*; D002983:Clinical Competence; D004059:Diffusion of Innovation; D005260:Female; D006282:Health Personnel / Q000193:education; D006291:Health Policy; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D014193:Trauma Centers / Q000592:standards*; D014481:United States; D055815:Young Adult
Alcohol; American College of Surgeons; dissemination and implementation research; motivational interviewing; policy mandate; screening and brief intervention; traumatic brain injury