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Implementation of a Hospital-Based Screening and Treatment Program for Unhealthy Alcohol Use
Jananie Ramesh1, Christopher Moriates2,3, John Embers4,5,6
1Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, TX, USA. jananie.ramesh@austin.utexas.edu.
Background:
Screening and treatment for unhealthy alcohol use (UAU) and alcohol use disorder (AUD) are recommended but underutilized, particularly in hospital settings.
Objective:
To determine whether a comprehensive screening and treatment protocol for UAU in hospitalized patients can help reduce alcohol use.
Design:
Quality improvement study at single-center safety-net hospital.
Participants:
27,914 patients were admitted from 9/2022 to 9/2024, and 18,146 (65.0%) were screened with AUDIT-PC, with 1085 (6.0%) screening positive (≥ 5). Substance use navigators (SUNs) identified 257 additional patients with UAU through referral methods.
Intervention:
SUNs approached eligible patients and conducted full AUDIT and brief behavioral counseling. Patients with AUDIT ≥ 12 were offered medications for AUD (MAUD) during hospitalization and at discharge.
Main Measures:
Intervention delivery, 30-day return hospital encounters (readmission or emergency department), and change in AUDIT score among high-risk patients.
Key Results:
Of the 1342 intervention-eligible patients, 81% were men, and the mean age was 51 years. 54% were Caucasian, 30% Hispanic/Latinx, and 9% Black. 17% were unhoused, and 18% were uninsured. Of these 1342, 800 (59.6%) patients engaged in the intervention. The mean AUDIT score was 15 (median 14, IQR 8-21). For the 489 (61.1%) patients with AUDIT ≥ 12, 231 (47.2%) were started on medication before discharge. For the 126 patients with repeat AUDIT (25.8%), the mean reduction was 14.2 points (95% CI: -15.4, -12.2). For those with AUDIT ≥ 12, 128 (26.2%) patients had a return hospital encounter within 30 days of discharge. Patients without return encounters had significantly larger reductions in AUDIT score than those who had return encounters (mean reduction -16.2 vs -9.1 points (difference -7.1, 95% CI: -3.1, -11.0)).
Conclusions:
UAU screening and risk-stratified treatment (including pharmacotherapy) can be delivered in diverse hospitalized patients, and were accompanied by short-term changes in alcohol risk score among patients reached for follow-up.
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