Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients

Abstract

Background: Performance measures for brief alcohol interventions (BIs) are currently based on provider documentation of BI. However, provider documentation may not be a reliable measure of whether or not patients are offered clinically meaningful BIs. In particular, BI documented with clinical decision support in an electronic medical record (EMR) could appear identical irrespective of the quality of BI provided. We hypothesized that differences in how BI was implemented across health systems could lead to differences in the proportion of documented BI recalled and reported by patients across health systems.

Methods: Male outpatients with unhealthy alcohol use identified by confidential satisfaction surveys (2009-2012) were assessed for whether they reported receiving BI in the past year (patient-reported BI) and whether they had BI documented in the EMR during the same period (documented BI). We evaluated and compared the prevalence of documented BI to patient-reported BI across 21 VA networks to determine whether documented BI had a variable association with patient-reported BI across the networks.

Results: Of 9896 eligible male outpatients with unhealthy alcohol use, 59.0% (95% CI 57.4-60.5%) reported BI (50.4-64.9% across networks) and 37.4% (95% CI 36.0-38.9%) had BI documented in the EMR (28.0-44.2% across networks). Overall, 72.9% (95% CI 70.8-75.5%) of patients with documented BI also reported BI. The association between documented BI and patient-reported BI did not vary across VA networks in adjusted logistic regression models.

Conclusions: Performance measures of BI that rely on provider documentation in EMRs appear comparable to patient report for comparing care across VA networks.

Keywords: Brief alcohol intervention; Patient self-report; Performance measurement; Provider documentation.

Fig. 1

Study sample. Note. Numbers in figure are unweighted. BI = brief intervention; EMR = electronic medical record.

Fig. 2

VA network weighted prevalence of patient-reported BI stratified by whether or not BI was documented in the EMR among patients who screened positive for unhealthy alcohol use on a confidential survey. Note. The number below the VA network letter indicates the number of patients in that network included in the study. Among patients who had documented BI, the prevalence of patient-reported BI varied across networks (p = 0.0220), while among patients who did not have documented BI, the prevalence of patient-reported BI did not vary across networks (p = 0.2858).