title: Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients.
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.
authors.affiliation: 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.
authors.forename: Gwen T
authors.initials: GT
authors.lastname: Lapham
authors.affiliation: 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.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Rubinsky
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States. Electronic address: shortreed.s@ghc.org.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Shortreed
authors.affiliation: 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.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Hawkins
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States. Electronic address: richards.je@ghc.org.
authors.forename: Julie
authors.initials: J
authors.lastname: Richards
authors.affiliation: 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.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.affiliation: 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.
authors.forename: Douglas
authors.initials: D
authors.lastname: Berger
authors.affiliation: 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.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Chavez
authors.affiliation: 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.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Kivlahan
authors.affiliation: 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.
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000628:therapy*; D003376:Counseling / Q000706:statistics & numerical data*; D000068598:Data Accuracy; D004282:Documentation / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D057566:Self Report; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Brief alcohol intervention; Patient self-report; Performance measurement; Provider documentation