QUERI – Quality Enhancement Research Initiative

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Alcohol Use Screening Clinical Reminder

Date: January 2008

The national VA clinical reminder for alcohol use screening is reproduced below. The VA performance measure for alcohol use screening requires that patients are screened with the AUDIT-C annually.

The AUDIT-C is a 3-question screen that measures a patient's alcohol consumption in the past year. It is scored on a scale of 0-12 with 4 or more considered a positive screen (3 or more for women).

Figure 1 shows the main clinical reminder screen. The help text describes the screening tool and then guides the user to either administer the AUDIT-C or enter a reason they are unable to screen that day.

Figure 1

Figure 1. The following text appears on the computer screen: A standardized tool to screen for hazardous or problem drinking should be administered to all patients. The AUDIT-C is a sensitive tool for identifying those patients who may be at risk of problems due to drinking. The risk of being alcohol dependent and experiencing problems due to drinking increases as AUDIT-C scores increase. AUDIT-C screening questions should be asked verbatim, in private setting and with a nonjudgmental manner. Perform AUDC. Unable to Screen. A link to the AUDIT-C Questionnaire appears at the bottom left of the computer screen.

Figure 2 shows the questions of the AUDIT-C in CPRS. When the user clicks on the "AUDIT-C" button (shown in Figure 1), the three questions of the screen appear. The user completes the screen by clicking an answer for each question then clicks OK.

A score is automatically generated based on the responses checked. If the answer to question one = never, the user may complete the screen by clicking OK without answering the other two questions, and the AUDIT-C score of zero will be sent to the system.

Figure 2

Figure 2. The following text appears on the computer screen: Please read each item carefully and select the correct answer for you. How often did you have a drink containing alcohol in the past year? Never. Monthly or less. Two to four times a month. Two to three times per week. Four or more times a week. Please read each item carefully and select the correct answer for you. How many drinks containing alcohol did you have on a typical day when you were drinking in the past year? 0 drinks. 1 or 2. 3 or 4. 5 or 6. 7 to 9. 10 or more. Please read each item carefully and select the correct answer for you. How often did you have six or more drinks on one occasion in the past year? Never. Less than monthly. Monthly. Weekly. Daily or almost daily.

As seen in Figure 3, the results and score of the screen show in the bottom half of the clinical reminder after the user hits the "OK" button. This text will be transferred to the CPRS progress note when the user completes the clinical reminder by clicking the "Finish" button.

Figure 3

Figure 3. Computer screen showing the results and score of the screen in the bottom half of the clinical reminder after the user hits the OK button.

Figure 4 shows the expanded "unable to screen" section with three options listed. Note that not screening due to cognitive impairment requires documentation with a valid screening measure.

At the bottom of the dialog box is a hyperlink to the AUDIT-C Questionnaire so the three AUDIT-C questions can be printed out to administer the alcohol screen on paper.

Figure 4

Figure 4. Computer screen showing the section with option to Perform AUDC or Unable to Screen. Under Unable to Screen three options are listed. Due to Acute Illness. Due to Chronic, Severe Cognitive Impairment. Comment. Cognitive impairment measured by a specific valid tool that is recorded in the patient's record will be considered as a valid exclusion for performance measure purposes. Refused alcohol screening.