Abstract
BackgroundVarious hospital accreditation and quality assurance entities in the United States have approved and endorsed performance measures promoting alcohol brief intervention (BI) for hospitalized individuals who screen positive for unhealthy alcohol use, the spectrum of use ranging from hazardous use to alcohol use disorders. These performance measures have been controversial due to the limited and equivocal evidence for the efficacy of BI among hospitalized individuals. The few BI trials conducted with hospital inpatients vary widely in methodological quality. While the majority of these studies indicate limited to no effects of BI in this population, none have been designed to account for the most pervasive methodological issue in BI studies presumed to drive study findings towards the null: assessment reactivity (AR).Methods/DesignThis is a three-arm, single-site, randomized controlled trial of BI for hospitalized patients at a large academic medical center affiliated with the U.S. Department of Veterans Affairs who use alcohol at hazardous levels but do not have an alcohol use disorder. Participants are randomized to one of three study conditions. Study Arm 1 receives a three-part alcohol BI. Study Arm 2 receives attention control. To account for potential AR, Study Arm 3 receives AC with limited assessment. Primary outcomes will include the number of standard drinks/week and binge drinking episodes reported in the 30-day period prior to a final measurement visit obtained 6 months after hospital discharge. Additional outcomes will include readiness to change drinking behavior and number of adverse consequences of alcohol use. To assess differences in primary outcomes across the three arms, we will use mixed-effects regression models that account for a patient’s repeated measures over the timepoints and clustering within medical units. Intervention implementation will be assessed by: a) review of intervention audio recordings to characterize barriers to intervention fidelity; and b) feasibility of participant recruitment, enrollment, and follow-up.DiscussionThe results of this methodologically rigorous trial will provide greater justification for or against the use of BI performance measures in the inpatient setting and inform organizational responses to BI-related hospital accreditation and performance measures.Trial registrationNCT01602172
Highlights
Various hospital accreditation and quality assurance entities in the United States have approved and endorsed performance measures promoting alcohol brief intervention (BI) for hospitalized individuals who screen positive for unhealthy alcohol use, the spectrum of use ranging from hazardous use to alcohol use disorders
In 2008, The Joint Commission (TJC), a hospital accreditation body in the United States, began the development and testing of a set of standardized hospital performance measures to address the entire spectrum of alcohol use through screening, brief intervention (BI) counseling, referral to specialty treatment, pharmacotherapy, and follow-up for hospitalized patients [4]
Hospitalization can be a window of opportunity in which to engage the patient who is drinking at hazardous levels in a BI discussion, linking alcohol use to acute/chronic health problems, and assessing and supporting personal motivation to change drinking behavior, if the hospital admission is alcohol related
Summary
Hospitalization can be a window of opportunity in which to engage the patient who is drinking at hazardous levels in a BI discussion, linking alcohol use to acute/chronic health problems, and assessing and supporting personal motivation to change drinking behavior, if the hospital admission is alcohol related. If our study demonstrates the efficacy of BI for reducing drinking in hospitalized patients, one could argue that we have generated evidence for the efficacy of BI in a “more severe” patient population of drinkers (i.e., those who exceed the NIAAA limits) and that its efficacy in a “less severe” group (i.e., those who “only” had a positive AUDIT-C screen) would still be in question. This assertion would be valid only if the AUDIT-C has a high rate of false negatives (i.e., patients who score negative on the AUDIT-C despite drinking above the NIAAA-specified limits). In one recent study of almost 500,000 individuals, only about five percent of men and three percent of women in the study had negative AUDIT-C screens, despite reported heavy episodic drinking (i.e., drinking above daily limits) [54]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
