CDS Connect: Brief Behavioral Counseling Interventions for Excessive Alcohol Consumption with Optional Referral to Treatment

Brief Behavioral Counseling Interventions for Excessive Alcohol Consumption with Optional Referral to Treatment

Description

This CDS artifact identifies patients screened for alcohol use using the U.S. or World Health Organization (WHO) version of the Alcohol Use Disorders Identification Test (AUDIT), and provides brief intervention care recommendations to consider based on the patient’s alcohol screening and reported level of drinking, including suggestions for brief interventions and links to targeted patient education materials and tools. The artifact also suggests and facilitates a referral for the patient to receive diagnostic evaluation and possible treatment of alcohol use disorder (AUD), if indicated.

Artifact Type
Creation Date
Version
1.0
Status
Experimental
True

Artifact Creation and Usage

Contributors

This artifact was developed by MITRE software engineers and clinical informaticists in collaboration with clinical subject matter experts and leaders from the Centers for Disease Control and Prevention (CDC) National Center on Birth Defects and Developmental Disabilities (NCBDDD).

License
IP Attestation The author asserts that this artifact has been developed in compliance with the intellectual property rights attributed to the source material.
Copyrights

© 2020 The MITRE Corporation. All Rights Reserved. Approved for Public Release: 20-1506. Distribution and Use of Artifacts and Associated Documentation Unlimited.

Implementation Details
Engineering Details

The CDS flow diagram pictured here provides a high level overview of the logic flow and some of the decision points specified in the CDS logic.

The semi-structured (i.e., human readable, Level 2) representation of the artifact is available in Appendix A of the implementation guide for this artifact. The structured (i.e., coded) CDS logic is attached to this artifact in the Logic File field. The code is expressed using Clinical Quality Language (CQL) and the Fast Healthcare Interoperability Resources (FHIR) Release 4 (R4) data model. All value sets referenced in the logic are published on the Value Set Authority Center (VSAC). Additional details about these resources can be accessed via the following URLs:

Open source resources associated with this CDS are available on GitHub here. The resources include:

  • asbi-intervention-app: a SMART on FHIR application that provides CDS interventions based on alcohol screening scores and patient information to assist clinicians with caring for patients based on their alcohol use
  • asbi-screening-app: a SMART on FHIR application that provides multiple alcohol screening instruments for assessing a patient's alcohol use
  • questionnaire-to-survey: a library for incorporating FHIR Questionnaires into SurveyJS
  • asbi-testing-server: a node-based FHIR server to be used for testing alcohol screening and brief intervention CDS 
Repository Information
Approval Date
Publication Date
Last Review Date
Knowledge Level

Structured code that is interpretable by a computer (includes data elements, value sets, logic)

Purpose and Usage
Purpose

This CDS identifies patients screened for alcohol use and provides brief intervention care recommendations to consider based on the patient’s alcohol screening results and reported level of drinking, including suggestions for brief counseling interventions and links to targeted patient education materials and tools. The artifact also suggests and facilitates a referral for the patient to receive diagnostic evaluation and possible treatment of alcohol use disorder, if indicated. 

Intended Population

This CDS is intended for adults (i.e., individuals 18 years old and older).

Usage

This artifact is intended for use by healthcare personnel working in primary healthcare settings who care for adults. This audience includes, "physicians, general practitioners, community health workers, behavioral health workers, health educators, nurses, social workers, psychologists, psychiatrists, obstetricians and midwives" (Babor, Higgins-Biddle, Robiana 2018).

Cautions
This artifact requires the availability of alcohol screening results using a version of the AUDIT questionnaire. It does not include alcohol screening: The CDS Development Team and CDC sponsors of this work took a modular approach to developing alcohol screening and brief intervention (ASBI) CDS artifacts to 1) lessen the complexity of each artifact and 2) enable organizations to only integrate portions of logic that they really need (e.g., are not already present in their health IT system). A modular approach allows for personalized implementation choices without the need to edit CDS code. The companion alcohol screening artifacts  Alcohol Screening Using the USAUDIT (Alcohol Use Disorders Identification Test, Adapted for Use in the United States); Alcohol Screening Using the World Health Organization (WHO) Alcohol Use Disorders Identification Test (AUDIT); and Alcohol Screening Using the National Institute on Drug Abuse Quick Screen (NIDA QS) and USAUDIT (Alcohol Use Disorders Identification Test, Adapted for Use in the United States) artifacts are also available on the CDS Connect Repository.
All care provided to the patient should be subject to clinical judgement: Clinicians are encouraged to consider the patient's medical condition, family history of alcohol problems and perceived honesty in responding to the AUDIT questions prior to making care decisions related to the patient's alcohol use (Babor et al. 2001).
Implementation Note: This artifact is not “standalone”. It is not intended to be completely plug-and-play (i.e., healthcare systems will need to integrate the artifact with components of their health information technology [IT] system for the artifact to work). Implementers should conduct extensive testing, including clinical testing in real-life workflows. It is expected that artifacts will be customized and adapted to local clinical and IT environments.
Test Patients
Supporting Evidence
References

The American College of Obstetricians and Gynecologists. (2011). At-Risk Drinking and Alcohol Dependence: Obstetric and Gynecologic Implications - ACOG. Retrieved January 21, 2020, from https://journals.lww.com/greenjournal/Citation/2011/08000/Committee_Opinion_No__496__At_Risk_Drinking_and.41.aspx

Babor, T. F., & Higgins-Biddle, J. C. (2001). Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/67210/WHO_MSD_MSB_01.6b.pdf?sequence=1

Babor, T. F., Higgins-Biddle, J. C., & Robaina, K. (2017). The Alcohol Use Disorders Identification Test, Adapted for Use in the United States: A Guide for Primary Care Practitioners, 24. Retrieved from https://www.ct.gov/dmhas/lib/dmhas/publications/USAUDIT-2017.pdf

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. Retrieved from https://www.who.int/substance_abuse/publications/audit/en/

Centers for Disease Control and Prevention. (2014). Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use A Step-by-Step Guide for Primary Care Practices. Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities. Retrieved from https://www.cdc.gov/ncbddd/fasd/documents/AlcoholSBIImplementationGuide.pdf

Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., … Wong, J. B. (2018). Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA - Journal of the American Medical Association, 320(18), 1899–1909. https://doi.org/10.1001/jama.2018.16789

National Institute on Alcohol Abuse and Alcoholism. (2019). Helping Patients Who Drink Too Much: A Clinician’s Guide. Retrieved from https://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf

World Health Organization. (2014). Guidelines for the identification and management of substance use and substance use disorders in pregnancy. WHO (Vol. 34). Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24783312

Artifact Decision Notes

Decisions made while developing this CDS are outlined in Appendix A of the accompanying implementation guide for this artifact.

Artifact Representation
Logic Files
Testing Experience
Pilot Experience

As of June 4, 2020, this CDS is in draft status and has not been tested in a clinical setting.