Disseminating alcohol screening and brief intervention at trauma centers: a policy-relevant cluster randomized effectiveness trial

Abstract

Background and aims: In 2005 the American College of Surgeons passed a mandate requiring that level I trauma centers have mechanisms to identify and intervene with problem drinkers. The aim of this investigation was to determine if a multi-level trauma center intervention targeting both providers and patients would lead to higher-quality alcohol screening and brief intervention (SBI) when compared with trauma center mandate compliance without implementation enhancements.

Design: Cluster randomized trial in which intervention site (site n = 10, patient n = 409) providers received 1-day workshop training on evidence-based motivational interviewing (MI) alcohol interventions and four 30-minute feedback and coaching sessions; control sites (site n = 10, patient n = 469) implemented the mandate without study team training enhancements.

Setting: Trauma centers in the United States of America.

Participants: A total of 878 blood alcohol-positive in-patients with and without traumatic brain injury (TBI).

Measurements: MI skills of providers were assessed with fidelity coded standardized patient interviews. All patients were interviewed at baseline and 6- and 12-months post-injury with the Alcohol Use Disorders Identification Test (AUDIT).

Findings: Intervention site providers consistently demonstrated enhanced MI skills compared with control providers. Intervention patients demonstrated an 8% reduction in AUDIT hazardous drinking relative to controls over the course of the year after injury (relative risk = 0.88, 95%, confidence interval = 0.79, 0.98). Intervention patients were more likely to demonstrate improvements in alcohol use problems in the absence of traumatic brain injury (TBI) (P = 0.002).

Conclusion: Trauma center providers can be trained to deliver higher-quality alcohol screening and brief intervention (SBI) than untrained providers, which is associated with modest reductions in alcohol use problems, particularly among patients without TBI.

Trial registration: ClinicalTrials.gov NCT00607620.

Keywords: Alcohol; American College of Surgeons; dissemination and implementation research; motivational interviewing; policy mandate; screening and brief intervention; traumatic brain injury.

Figure 1

Flow of clusters (trauma centers) and participants (patients) through the trial

Figure 2

At-risk drinking by treatment group among patient with and without traumatic brain injury (TBI). Baseline time point assesses alcohol use problems in the 12-months prior to the index injury admission