# Presentation: 690434

## Using Mental Health Assistant AUDIT-C data to describe patterns of alcohol useCarol Achtmeyer, Emily C. Williams, Kathleen Lysell, Bryan Volpp,  Katharine A. BradleyPresented byCarol Achtmeyer, MN ARNP

- VA Quality Enhancement Research Initiative
- VA  Health Services Research & Development
- VA Center of Excellence in Substance Abuse Treatment & Education
- VA Puget Sound Primary and Specialty Medicine
- _[carol.achtmeyer@va.gov](mailto:carol.achtmeyer@va.gov)_

##      The Mental Health Assistant (MHA)

- Tool to administer/score MH screening tests
- AUDIT-C most common
- Over 5 million since 2003
- Usually used via Clinical Reminders (CR)
- MHA data stored as “response strings”
- Sequence of numbers/letters
- Correlate to answers of screening questions

##       The MHA AUDIT-C

- Currently used in Alcohol Use Screen CR
- 3-digit response strings to AUDIT-C
- i.e. 323, 124, 444
- Response Strings can determine:
- Answers to individual questions
- Total AUDIT-C score
- Frequency of alcohol use patterns

##      Extracting Response Strings

- Text answers to questions in patient chart
- Response strings not viewable within CPRS
- Response strings stored in VistA
- Psych Instrument Patient File
- Extract using fileman query

## Scoring the AUDIT-C

- Item checked equals **2 points**

- Item checked equals **2 points**

**0****1****2****3****4**

**0****0****1****2****3****4**

**0****1****2****3****4**

- POINTS

## Scoring the AUDIT-C

- Item checked = 2 points

- Item checked = 1 points

- Item checked = 1 points

- Score = 4 String = 211

##       Interpreting AUDIT-C MH data

- Total Score can be interpreted in variety of ways
- Depends on answers to individual questions
- AUDIT-C of 4 may indicate risky or non risky drinking
- 310 : drinks 2-4 times/week, 3-4/occ, never >6
- not over recommended limits = non risky drinking
- 211 : drinks 2-4x/mo, 3-4/occ, less than monthly > 6 drinks
- over recommended limits = risky drinking

##      MHA AUDIT-C Data

- Data extracted VA facility for 2 year period
- fileman query
- Evaluated frequency of response patterns
- No patient level data
- Aggregate data
- De-identified

## Results

- 65,484 AUDIT-C response strings
- 90 combinations of response strings identified

##      Results Continued

- Most common string = 400
- N=11387, 17% of all scores
- Represents non risky drinking
- 1249 occurrences where score was 4, but pattern was risky drinking
- i.e. 211,301,112
- 9% of all scores of 4 represented risky drinking

##        Response String Frequency

## Changes in MHA3

- New functionality coming in clinical reminders patch 6
- Allow cohort or resolution logic according to individual response strings
- Many new tests in MHA3
- PTSD
- PHQ9
- Braden Scale
- All generate response strings in a similar way to AUDIT-C

##           More Changes 

- Data from MHA3 will no be sent to centralized data base, allow for greater analysis and national trends for commonly administered MHA tests
- MHA3 will be available on CPRS toolbar
- Greater presence in CPRS

##            Summary

- The Mental Health Assistant will soon be more widely accessible in CPRS
- MHA3 contains more screening tests than previously available
- Data generated from these screening tests can be extracted via fileman queries (and eventually via national data base)
- These data allow for analysis of patterns and trends
- MHA response strings can be useful in creating custom clinical reminders based on responses to individual questions

## Changes in alcohol screening

- Performance Measure likely for FY 08
- Probable AUDIT-C cut off 5 to require counseling
- Scores of 4 may still benefit from counseling if pattern reflects risky drinking

## Fileman: Extract AUDIT-C Response Strings

- PSYCH INSTRUMENT PATIENT
-  Select Local Fileman with Inq.Pr.Se.List.Exp. Option: PR  Print File Entry
- OUTPUT FROM WHAT FILE: PSYCH INSTRUMENT PATIENT//
- NAME: FILEMAN QUERY FOR AUDIT-C RESPONSE STRINGS
- SORT BY: INSTRU["AUD";L1// PSYCH INSTR PT NCHCS
-    By 'INSTRU', do you mean PSYCH INSTRUMENT PATIENT 'INSTRUMENT'? Yes//   (Yes)
-   WITHIN INSTRU["AUD", SORT BY: INSTRUMENT//     (multiple)
-   INSTRUMENT SUB-FIELD: DATE//     (multiple)
-   DATE SUB-FIELD: COMPLETION DATE//
- START WITH COMPLETION DATE: Jan 1,2007//   (JAN 01, 2007)
-   GO TO COMPLETION DATE: AUG 01,2007//   (AUG 01, 2007)
-     WITHIN COMPLETION DATE, SORT BY:
- STORE IN 'SORT' TEMPLATE:
- FIRST PRINT FIELD: INSTRUMENT//     (multiple)
-   FIRST PRINT INSTRUMENT SUB-FIELD: DATE//     (multiple)
-     FIRST PRINT DATE SUB-FIELD: COMPLETION DATE;X//
-     THEN PRINT DATE SUB-FIELD: "!"//
-     THEN PRINT DATE SUB-FIELD: RESPONSE STRING1;X//
-     THEN PRINT DATE SUB-FIELD: "!"//
-     THEN PRINT DATE SUB-FIELD: NAME;X//
- (May jump to patient file for demographics)
- Note: file structure will change with MHA3 requiring rewrite of above query.
-          However, above query may be used to pull historical AUDIT-C response strings

## Questions?

##        AUDIT-C Scoring (text version)