Implementation of a Hospital-Based Screening and Treatment Program for Unhealthy Alcohol Use.

Area of Science:

• Public Health
• Clinical Medicine
• Quality Improvement

Background:

• Screening and treatment for unhealthy alcohol use (UAU) and alcohol use disorder (AUD) are recommended but underutilized, particularly in hospital settings.
• Hospitalized patients represent a critical population for intervention due to potential for acute care and follow-up.
• Addressing UAU and AUD in hospitals can improve patient outcomes and reduce healthcare utilization.

Purpose of the Study:

• To determine if a comprehensive screening and treatment protocol for UAU in hospitalized patients can effectively reduce alcohol use.
• To assess the feasibility and impact of integrating UAU screening and treatment into routine hospital care.
• To evaluate the effectiveness of a risk-stratified approach to UAU intervention.

Main Methods:

• A quality improvement study was conducted at a single-center safety-net hospital.
• Over 27,000 patients were admitted, with over 18,000 screened using AUDIT-PC; substance use navigators (SUNs) identified additional patients with UAU.
• Eligible patients received full AUDIT screening, brief behavioral counseling, and, if indicated (AUDIT ≥ 12), medications for AUD (MAUD) during hospitalization and at discharge.

Main Results:

• Of 1342 eligible patients, 800 (59.6%) engaged in the intervention. The mean AUDIT score was 15.
• Among patients with AUDIT ≥ 12, 47.2% received MAUD before discharge. For those with repeat AUDIT, a mean reduction of 14.2 points was observed.
• Patients without 30-day return hospital encounters showed significantly greater reductions in AUDIT scores compared to those with return encounters.

Conclusions:

• UAU screening and risk-stratified treatment, including pharmacotherapy, are deliverable in diverse hospitalized patient populations.
• The protocol demonstrated short-term reductions in alcohol risk scores among patients engaged in follow-up.
• Integrating UAU interventions into hospital settings holds promise for improving patient health and reducing readmissions.