Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients.
Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement.



Using data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis.



Among 1082 HIV+ and 1160 uninfected men, 14% and 22% had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9% and 14% had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa=0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa=0.46). Moderate agreement was consistent across subgroups.



EMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening.
Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT, United States. Electronic address: kathleen.mcginnis3@va.gov.
Kathleen A
KA
McGinnis
Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT, United States; Division of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States.
Janet P
JP
Tate
Yale University School of Public Health, New Haven, CT, United States; VA Health Services Research & Developments, Denver-Seattle Center for Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States.
Emily C
EC
Williams
Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT, United States.
Melissa
M
Skanderson
Department of Health Services, University of Washington, Seattle, WA, United States.
Kendall J
KJ
Bryant
National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Adam J
AJ
Gordon
National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States.
Kevin L
KL
Kraemer
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States.
Stephen A
SA
Maisto
Department of Psychology, Syracuse University, Syracuse, NY, United States.
Steven
S
Crystal
Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT, United States; Division of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States; Health Services Research, Rutgers University, New Brunswick, NJ, United States.
David A
DA
Fiellin
Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT, United States; Division of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States; Health Services Research, Rutgers University, New Brunswick, NJ, United States.
Amy C
AC
Justice
D000328:Adult; D000428:Alcohol Drinking; D000437:Alcoholism / Q000150:complications*; D015331:Cohort Studies; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014728:Veterans / Q000706:statistics & numerical data
AUDIT-C; Alcohol consumption; Electronic health record; HIV; Population-based screening; Veterans
AIDS Patient Care STDS. 2016 May;30(5):200-7
27158847
J Gen Intern Med. 2004 Apr;19(4):366-74
15061746
Alcohol Alcohol. 2010 Mar-Apr;45(2):159-66
20061510
J Gen Intern Med. 2008 Jun;23(6):781-7
18421511
Subst Abus. 2007;28(3):53-65
18077303
Addiction. 2014 Sep;109(9):1472-81
24773590
Alcohol Res Health. 2010;33(3):267-79
23584068
AIDS Behav. 2016 Jan;20 Suppl 1:S1-18
26362168
Arch Intern Med. 1998 Sep 14;158(16):1789-95
9738608
J Public Health (Oxf). 2005 Sep;27(3):281-91
15870099
J Gen Intern Med. 2011 Mar;26(3):299-306
20859699
AIDS Behav. 2016 Mar;20(3):504-11
26936030
Sex Transm Dis. 2005 Mar;32(3):156-64
15729152
Addiction. 2013 Jul;108(7):1230-40
23432593
J Stud Alcohol. 2002 Mar;63(2):179-86
12033694
N Engl J Med. 2005 Feb 10;352(6):596-607
15703424
Med Care. 2013 Oct;51(10):914-21
23969582
Int J STD AIDS. 1999 Sep;10(9):561-70
10492422
Med Care. 2006 Aug;44(8 Suppl 2):S31-6
16849966
J Acquir Immune Defic Syndr. 2012 Oct 1;61(2):171-8
22820808
AIDS Care. 2007 Apr;19(4):459-66
17453583
J Acquir Immune Defic Syndr. 2015 Oct 1;70(2):137-45
25967270
J Acquir Immune Defic Syndr. 2007 Dec 1;46(4):443-50
18077833
Alcohol Clin Exp Res. 2013 Mar;37(3):435-42
23050632
J Gen Intern Med. 2009 Jul;24(7):881-3
19495888
Am J Med. 2005 Aug;118(8):890-8
16084183
Med Care. 2006 Aug;44(8 Suppl 2):S52-60
16849969
AIDS Behav. 2016 Jan;20 Suppl 1:S19-39
26080689
Nicotine Tob Res. 2011 Dec;13(12):1233-9
21911825
Arch Intern Med. 2003 Apr 14;163(7):821-9
12695273
Am J Manag Care. 2006 Oct;12(10):597-606
17026414
J Acquir Immune Defic Syndr. 2012 Jul 1;60(3):282-8
22495786
Alcohol Clin Exp Res. 2007 Jul;31(7):1208-17
17451397
J Gen Intern Med. 2015 Aug;30(8):1125-32
25731916
J Am Med Inform Assoc. 2004 Sep-Oct;11(5):339-43
15187071
Clin Infect Dis. 2014 May;58(10):1449-58
24569533
Alcohol Clin Exp Res. 2003 May;27(5):862-7
12766632
Biometrics. 1977 Mar;33(1):159-74
843571
Drug Alcohol Depend. 2016 Apr 1;161:95-103
26861883
J Acquir Immune Defic Syndr. 2015 Dec 15;70(5):503-9
26226250
Curr HIV/AIDS Rep. 2013 Dec;10(4):314-23
24078370
J Acquir Immune Defic Syndr. 2009 Oct 1;52(2):180-202
19668086
Alcohol Clin Exp Res. 2004 Apr;28(4):572-7
15100608
Alcohol Clin Exp Res. 2005 Jul;29(7):1190-7
16046874
AIDS Behav. 2016 Jul 8;:
27392417
Health Educ Q. 1986 Winter;13(4):359-71
3781860