Interventions for Unhealthy Alcohol Use: SmartSet for Note Documentation, Referrals, and Medications

Description
Flow diagram showing logic used to create electronic health record tools (SmartSet) to facitate interventions and follow up for patients in primary care practices who have screened positive for unhealthy alcohol use 
Artifact Type
Creation Date
Version
0.1
Status
Experimental
True

Artifact Creation and Usage

Contributors
Dan Jonas, Colleen Barclay, Shana Ratner, Julia Tompkins
IP Attestation The author asserts that this artifact has been developed in compliance with the intellectual property rights attributed to the source material.
Repository Information
Approval Date
Publication Date
Last Review Date
Knowledge Level

Semi-structured text that describes the recommendations for implementation in CDS

Purpose and Usage
Purpose
The logic diagram is intended to guide practices and health systems in creating a electronic health record tool to facilitate note documentation and  interventions for unhealthy alcohol use in primary care practices
Intended Population
This artifact is intended for use in an adult population aged 18 and older without a history of AUD
Usage
Intended for use by primary care clinical/medical directors in position to implement screening for unhealthy alcohol use
Cautions

PLEASE NOTE: The 2013 evidenced-based source that this artifact was derived from was updated by the USPSTF in 2018. The updated recommendation is available here: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-interventions

Supporting Evidence
Source Description
Based on 2013 USPSTF Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care recommendation
References
Final Recommendation Statement: Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care. U.S. Preventive Services Task Force. May 2013.
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/alcohol-misuse-screening-and-behavioral-counseling-interventions-in-primary-care;

Barclay C, Viswanathan M, Ratner S, Tompkins J, Jonas DE. Implementing Evidence-based Screening and Counseling for Unhealthy Alcohol Use with Epic-based Electronic Health Record Tools: A Guide for Clinics and Health Systems, Developed as Part of a Pilot Dissemination Project (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No.290-2015-00011-I.) AHRQ Publication No. 18-EHC020-1-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2018. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCMETHENGAGEALCOHOLGUIDE

Barclay C, Viswanathan M, Jonas DE. Development of a Primary Care Guide for Implementing Evidence-based Screening and Counseling for Unhealthy Alcohol Use with Epic-based Electronic Health Record Tools: A Pilot Dissemination Project. Methods Research Report. (Prepared by RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2015-00011-I). AHRQ Publication No. 18-EHC020-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2018. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCMETHENGAGEALCOHOL
Recommendation
The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse
Strength of Recommendation
Grade B
Quality of Evidence
See full recommendation report 
Artifact Decision Notes
Decision notes are outlined in the attached implementation guide
Artifact Representation
Triggers
The electronic health record tool (SmartSet) is intended to be opened by a provider when the Alcohol Screen Positive Best Practice Alert is triggered at a subsequent visit after a patient has had a positive Initial alcohol screen and positive AUDIT score, and no documentation of brief intervention, counseling, or referral
Inclusions
1) Patient age ≥18 years
2) Initial positive screen for unhealthy alcohol use (i.e., response of “1 or more” to the question “How many times in the past year have you had 4 or more drinks in a day?” for all women and anyone ≥65 years old, or “…5 or more…” for men <65). This information comes from the initial alcohol screen BPA and related flowsheet.
3) Total AUDIT score of ≥4 (women and anyone ≥65 years old) or ≥5 (men <65), OR ≥2 points from questions 4-6 of the AUDIT for anyone. This information comes from the AUDIT flowsheet.
Exclusions
Previously diagnosed alcohol use disorder (AUD) (History, Problem List, encounter or hospital diagnosis)
OR
Terminal illness/Hospice Diagnosis (History, Problem List, encounter or hospital diagnosis)
OR
Documentation of brief intervention, counseling, or referral at the time that the Alcohol Screen was determined to be Positive
Interventions and Actions
Provider selects actions for note documentation and After-Visit Summary; referrals; medications and vitamins orders; and follow up 
Testing Experience