![](media/image1.png){width="5.972916666666666in"
height="0.4791666666666667in"}

Top of Form

## Complete Summary

#### TITLE

Appropriate screening: percent of eligible patients screened annually
for alcohol misuse with AUDIT-C.

#### 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 eligible patients screened
annually for alcohol misuse with the 3-item Alcohol Use Disorders
Identification Test (AUDIT-C).

#### RATIONALE

Alcohol screening is recommended for all adult patients. Screening is
not aimed just at alcohol dependent individuals, but also at the far
larger population of patients with alcohol misuse who can benefit from
brief primary care counseling. About 20% of Veterans Administration (VA)
primary care patients screen positive for alcohol misuse, which ranges
from drinking above recommended limits without problems (risky drinking)
to severe alcohol use disorders (alcohol dependence). For veterans using
the VA healthcare system, alcohol misuse is associated with
psychosocial, legal, or employment problems and personal suffering, as
well as with adverse health outcomes. The VA requires screening for
alcohol misuse (including risky and harmful drinking, alcohol abuse and
alcohol dependence) first because alcohol misuse is associated with
increased morbidity and mortality. Medical problems due to alcohol
dependence include alcohol withdrawal syndrome, hepatitis, cirrhosis,
pancreatitis, thiamine deficiency, neuropathy, and cardiomyopathy.
Secondly, VA requires screening for alcohol misuse because the brief
counseling triggered as a result of screening has been shown to decrease
drinking and improve health outcomes. 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. Alcohol dependence represents only one end of the
spectrum of alcohol misuse and many drinkers who are not alcohol
dependent have medical or social problems attributable to alcohol.
Further, other asymptomatic drinkers are at risk for future problems due
to chronic, heavy alcohol use or episodic heavy drinking. Because
patients who drink above recommended limits (without alcohol dependence)
far outnumber patient with alcohol dependence, the non-dependent
drinkers account for the majority of alcohol-related morbidity and
mortality in the general population. There is a dose-response
relationship between average daily alcohol consumption and elevations in
blood pressure and risk of cirrhosis, hemorrhagic stroke, trauma and
cancers of the oropharynx, larynx, esophagus, and liver.

Recommended Drinking Limits: Based on the accumulated epidemiological
evidence, individuals who drink above the following levels are at
increased risk for adverse consequences of drinking:

-   14 drinks/week typically for men, 7 drinks/week typically for women,
    or

-   4 drinks on an occasion for men, 3 drinks on an occasion for women.

#### PRIMARY CLINICAL COMPONENT

Alcohol misuse; screening; 3-item Alcohol Use Disorders Identification
Test (AUDIT-C)

#### DENOMINATOR DESCRIPTION

Patients from the NEXUS Clinics cohort eligible for alcohol misuse
screening (see the related \"Denominator Inclusions/Exclusions\" field
in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients screened annually for alcohol misuse with the 3-item Alcohol
Use Disorders Identification Test (AUDIT-C) with item-wise recording of
item responses, total score and positive or negative result of the
AUDIT-C in medical record (see the related \"Numerator
Inclusions/Exclusions\" field 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

### 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\
Behavioral Health Care\
Substance Use Treatment Programs/Centers

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

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

#### 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

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

See the \"Rationale\" field.

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Patients from the NEXUS Clinics cohort\*

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

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients from the NEXUS Clinics cohort\* eligible for alcohol misuse
screening\*\*

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

\*\*Patients eligible for alcohol misuse screening if they are both:

-   Patients in the NEXUS cohort including patients who are currently in
    alcohol treatment or patients who are deemed non-drinkers

> AND

-   Patients whose annual screen is due on or after October 1, 2007.

**Exclusions**\
Patients with documented moderate or severe cognitive impairment. Refer
to the original measure documentation for additional details.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter\
Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window precedes index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients screened annually for alcohol misuse\* with the 3-item Alcohol
Use Disorders Identification Test (AUDIT-C) with item-wise recording of
item responses, total score and positive or negative result of the
AUDIT-C in medical record

\***Note**:

-   *Acceptable screening for alcohol misuse*: Alcohol screening must be
    accomplished by the use of the AUDIT-C. Required components of
    AUDIT-C screening include: documentation of responses to each
    question, documentation of the AUDIT-C screening score, and
    documentation of whether the patient screened positive or negative
    on the AUDIT-C. **Note**: Telephone screening is not acceptable.

-   *Screened annually*: Screening must be accomplished annually. Annual
    screening will be based upon the 12 months prior to \'study
    interval\' beginning date extending to the end of that month except
    for the last two pull lists of the fiscal year where annual
    screening is counted if it occurred in the prior 12 months through
    the \'study interval\' end date.

**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

Encounter or point in time

#### DATA SOURCE

Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

3-item Alcohol Use Disorders Identification Test (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

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Screening for alcohol misuse with AUDIT-C.

#### 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

[Mission Critical
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=12145)

#### MEASURE SUBSET NAME

[Appropriate
Screening](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=3&doc=9224)

#### 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

2002 Nov

#### REVISION DATE

2007 Oct

#### MEASURE STATUS

This is the current release of the measure.

This measure updates a previous version: Office of Quality and
Performance (10Q). FY 2005 VHA executive career field network director
performance measurement system and JCAHO hospital core measures.
Technical manual. Washington (DC): Veterans Health Administration (VHA);
2005 Mar 9. 244 p.

#### 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, \"Screening for Alcohol Misuse With AUDIT-C,\"
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 on November 9, 2004. The
information was verified by the measure developer on December 10, 2004.
This NQMC summary was updated by ECRI Institute on February 7, 2008. The
information was not verified by the measure developer.

#### COPYRIGHT STATEMENT

No copyright restrictions apply.

### Disclaimer

#### NQMC DISCLAIMER

The National Quality Measures Clearinghouse™ (NQMC) does not develop,
produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public and private organizations, other government
agencies, health care organizations or plans, individuals, and similar
entities.

Measures represented on the NQMC Web site are submitted by measure
developers, and are screened solely to determine that they meet the NQMC
Inclusion Criteria which may be found at
<http://www.qualitymeasures.ahrq.gov/about/inclusion.aspx>.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or its reliability and/or validity of the quality
measures and related materials represented on this site. The inclusion
or hosting of measures in NQMC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact
the measure developer.

Bottom of Form

© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008