Probability and Predictors of Patients Converting from Negative to Positive Screens for Alcohol Misuse

Authors

  • Gwen T. Lapham,

    Corresponding author
    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. Department of Health Services, University of Washington, Seattle, Washington
    3. Group Health Research Institute, Seattle, Washington
    • Reprint requests: Gwen T. Lapham, PhD, MPH, MSW, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101; Tel.: 206-277-4583; Fax 206-764-2935; E-mail: gwendolyn.lapham@va.gov

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  • Anna D. Rubinsky,

    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. Department of Health Services, University of Washington, Seattle, Washington
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  • Patrick J. Heagerty,

    1. Department of Health Services, University of Washington, Seattle, Washington
    2. Department of Biostatistics, University of Washington, Seattle, Washington
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  • Carol Achtmeyer,

    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. Center of Excellence in Substance Abuse Treatment and Education (CESATE), Seattle, Washington
    3. General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
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  • Emily C. Williams,

    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. Department of Health Services, University of Washington, Seattle, Washington
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  • Eric J. Hawkins,

    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. Center of Excellence in Substance Abuse Treatment and Education (CESATE), Seattle, Washington
    3. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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  • Charles Maynard,

    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. Department of Health Services, University of Washington, Seattle, Washington
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  • Daniel R. Kivlahan,

    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
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  • David Au,

    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
    3. Department of Medicine, University of Washington, Seattle, Washington
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  • Katharine A. Bradley

    1. Health Services Research & Development (HSR&D) Northwest Center of Excellence, Seattle, Washington
    2. Department of Health Services, University of Washington, Seattle, Washington
    3. Group Health Research Institute, Seattle, Washington
    4. Center of Excellence in Substance Abuse Treatment and Education (CESATE), Seattle, Washington
    5. Department of Medicine, University of Washington, Seattle, Washington
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Abstract

Background

Medicare reimburses providers for annual alcohol screening. However, the benefit of rescreening patients a year after a negative screen for alcohol misuse is unknown. We hypothesized that some subgroups of patients who screen negative would have a very low probability of converting to a positive subsequent screen (e.g., <0.1%), calling into question the value of annual alcohol screening for some patient subgroups.

Methods

This retrospective cohort study estimated the probability of converting to a positive screen for alcohol misuse a year after a negative screen among outpatients from 30 Veterans Health Administration (VA) medical centers. Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) alcohol screening scores (range 0 to 12 points) from 2004 to 2008 were obtained from electronic health record data. Eligible patients screened negative on their initial screen (AUDIT-C scores 0 to 3 for men; 0 to 2 for women). The main outcome was a positive subsequent screen (AUDIT-C scores ≥4 men; ≥3 women).

Results

Among 21,081 women and 323,913 men who screened negative on an initial screen, 5.4% and 6.0%, respectively, screened positive a year later. The adjusted probability of converting to a positive subsequent screen varied from 2.1 to 38.9% depending on age, gender, and initial negative screen score. Women, older patients, and those with initial AUDIT-C scores of 0 were least likely to a convert to a positive subsequent screen, while younger men with AUDIT-C scores of 3 were most likely to a convert to a positive subsequent screen.

Conclusions

The probability of a positive subsequent screen varied depending on age, gender, and initial negative screen score but exceeded 2% in all patient subgroups. Annual rescreening appears reasonable for all VA patients who had a negative screen the year prior.

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