Email UpdatesFlow diagrams showing logic used to create electronic health record tools (Best Practice Alerts) to facilitate screening and interventions for unhealthy alcohol use in primary care practices
Artifact Creation and Usage
Dan Jonas, Colleen Barclay, Shana Ratner, Julia Tompkins
Semi-structured text that describes the recommendations for implementation in CDS
The logic diagrams are intended to guide practices and health systems in creating electronic health record tools to faciiltate screening and interventions for unhealthy alcohol use in primary care practices
This artifact is intended for use in an adult population aged 18 and older without a history of AUD
Intended for use by primary care clinical/medical directors in position to implement screening for unhealthy alcohol use
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
Based on 2013 USPSTF Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care recommendation
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
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
Grade B
See full recommendation report
Decision notes are outlined in the attached implementation guide
The electronic health record tools (best practice alerts [BPAs]) are intended to fire during office visits when a patient is elegible for routine screening for unhealthy alcohol use
Patient age ≥18 years
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)
Initial Alcohol Screen BPA:
Nurse administers initial screening questions and enter responses in the Initial Alcohol Screen Flowsheet;
Documents reasons if screening is not performed;
Provides patient with AUDIT form if initial screen is positive
Incomplete Alcohol Screen BPA:
Nurse provides patient with Alcohol Use Disorders Inventory Test before provider starts the visit;
Documents AUDIT results or reasons that AUDIT is not indicated
Alcohol Screen Positive, Brief Intervention or Other intervention Needed BPA:
Provider selects action to:
a) Open SmartSet (tool for documentation, referrals, orders, and follow up);
b) Add to assessment to Problem list;
c) Select reason that intervention is delayed or declined