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## Complete Summary

#### TITLE

Alcohol misuse: percent of patients screened for alcohol misuse with
AUDIT-C who meet or exceed a threshold score of 5 who have timely brief
alcohol counseling.

#### SOURCE(S)

Office of Quality and Performance (10Q). FY 2008, Q1 technical manual
for the VHA performance measurement system. Washington (DC): Washington
(DC); 2007 Oct 31. 315 p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percent of patients screened for
alcohol misuse with Alcohol Use Disorders Test-Consumption (AUDIT-C) who
meet or exceed a threshold score of 5 who have timely brief alcohol
counseling.

#### RATIONALE

Most patients who screen positive on the Alcohol Use Disorders
Test-Consumption (AUDIT-C) will be hazardous drinkers who are not
alcohol dependent. By using both the AUDIT-C score, and the patient\'s
history of alcohol dependence (based on previously diagnosed alcohol
dependence of history of alcohol treatment or Alcoholics Anonymous
\[AA\] attendance), it is possible to identify those most likely to be
currently alcohol dependent. For patients who have never been diagnosed
as alcohol dependent or in alcohol treatment (or attended AA), AUDIT-C
scores greater than 8 are associated with relatively high rates of
current dependence. Patients who have had past alcohol treatment are at
high risk of current dependence with any positive AUDIT-C score greater
than 5. Among Veterans Affairs (VA) general medical patients who screen
positive for hazardous or problem drinking, 21% report prior alcohol
treatment or AA attendance. Brief counseling triggered as a result of
screening has been shown to decrease drinking and adverse health
outcomes and is recommended by the US Preventive Services Task Force
(USPSTF). In 2006, the National Commission for Prevention Priorities
sponsored by the Centers for Disease Control and the Agency for
Healthcare Research and Quality identified brief alcohol counseling as
one of the top ten national prevention priorities based on clinically
preventable burden of disease and cost-effectiveness. For patients who
have severe alcohol misuse (often alcohol use disorders), referral to
specialized addictions treatment is often indicated. Screening with
appropriate follow-up (brief counseling with specialty referral as
indicated) has two distinct and related goals. Like assessments and
counseling for smoking, it retains the focus on helping patients change
unhealthy behaviors (risky drinking) even if they are not alcohol
dependant. Like mental health disorders (depression and posttraumatic
stress disorder \[PTSD\]) it identifies patients who have alcohol use
disorders (alcoholism) and will benefit from more intensive
interventions than brief counseling.

#### PRIMARY CLINICAL COMPONENT

Alcohol; brief alcohol counseling

#### DENOMINATOR DESCRIPTION

Patients from the NEXUS Clinic cohort screened for alcohol misuse with
AUDIT-C who meet or exceed a threshold score of 5 (see the related
\"Denominator Inclusions/Exclusions\" in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients screened for alcohol misuse with AUDIT-C who meet or exceed a
threshold score of 5 who have brief alcohol counseling documented in the
medical record within 24 hours of the positive screen (see the related
\"Numerator Inclusions/Exclusions\" in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

-   One or more research studies published in a National Library of
    Medicine (NLM) indexed, peer-reviewed journal

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Screening and behavioral counseling interventions in primary care
    to reduce alcohol misuse: recommendation
    statement.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=4618)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

External oversight/Veterans Health Administration\
Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Nurses\
Physician Assistants\
Physicians\
Psychologists/Non-physician Behavioral Health Clinicians\
Social Workers

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Unspecified

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

See the \"Rationale\" field.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Timeliness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients from the NEXUS Clinic cohort\* screened for alcohol misuse with
AUDIT-C who meet or exceed a threshold score of 5

\*Refer to original measure documentation for patient cohort
description.

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients\* from the NEXUS Clinic cohort\* screened for alcohol misuse
with AUDIT-C who meet or exceed a threshold score of 5

\**Patient eligible for brief alcohol counseling*: Patients who have
been screened for alcohol misuse with the AUDIT-C *after October 1,
2007* and had a AUDIT-C total score of 5 or greater (**Note**: Although
positive scores on the AUDIT-C are a total score of 4 or greater for men
OR 3 or greater for women, and these patients with a positive score in
the range of 3 or 4 may benefit from evidence-based brief alcohol
counseling, they are not included in the Fiscal Year 08 Performance
Measure in an effort to decrease false positives and increase focus on
patients most at risk due to drinking and most ready to change.)

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Diagnostic Evaluation\
Encounter

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients screened for alcohol misuse with AUDIT-C who meet or exceed a
threshold score of 5 who have brief alcohol counseling\* documented in
the medical record within 24 hours of the positive screen

\**Acceptable components of evidence-based brief alcohol counseling*:
Brief alcohol counseling is recommended by the United States Preventive
Services Task Force (USPSTF) and Veterans Administration/Department of
Defense (VA/DOD) guidelines. Brief alcohol counseling refers to those
practices that aim to identify a real or potential alcohol problem and
motivate an individual to do something about it. For patients to be
considered as having received acceptable brief alcohol counseling, two
essential components must be documented:

-   Feedback linking drinking to health, which may be either

    -   Personalized counseling regarding relationship of alcohol to the
        patient\'s specific health issues\
        OR

    -   General alcohol-related counseling regarding relationship of
        alcohol to health (not linked to patient issues)

> AND

-   Advice to abstain from drinking alcoholic beverages OR to drink
    within specified recommended limits (**Note**: Documentation that
    patient drinks within recommended limits as self-reported are not
    acceptable to meet this requirement. Patient must be explicitly
    advised to drink within specified recommended limits.)

**Note**: Telephone counseling is now acceptable.

Although referral to specialty care may be appropriate for some
patients, screening and routine referral without documented brief
alcohol counseling is not sufficient to satisfy the measure.

Refer to original measure documentation for additional details.

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Fixed time period

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Alcohol Use Disorders Test-Consumption (AUDIT-C)

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Prescriptive standard

#### PRESCRIPTIVE STANDARD

Fiscal Year (FY) 2008 targets for alcohol screening (NEXUS Clinics):

-   Facility Floor: ??

-   Meets Target: ??

-   Exceeds Target: ??

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Brief alcohol counseling for alcohol misuse screening result of 5 or
greater.

#### MEASURE COLLECTION

[Fiscal Year (FY) 2008: Veterans Health Administration (VHA) Performance
Measurement
System](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=10202)

#### MEASURE SET NAME

[Transformational
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=12146)

#### MEASURE SUBSET NAME

[Seamless Continuum of
Care](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=10221)

#### DEVELOPER

Veterans Health Administration

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Unspecified

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Unspecified

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

Office of Quality and Performance (10Q). FY 2008, Q1 technical manual
for the VHA performance measurement system. Washington (DC): Washington
(DC); 2007 Oct 31. 315 p.

#### MEASURE AVAILABILITY

The individual measure, \"Brief Alcohol Counseling for Alcohol Misuse
Screening Result of 5 or Greater,\" is published in \"FY 2008 VHA
Performance Measurement System: Technical Manual.\"

For more information contact:

Department of Veterans Affairs\
Office of Quality and Performance (10Q)\
ATTN: Lynnette Nilan, E-mail: <lynnette.nilan@va.gov> or\
Tammy Czarnecki, E-mail: <tammy.czarnecki2@va.gov>

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on May 9, 2008. The
information was not verified by the measure developer.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008