AHRQ's new initiative to reduce Unhealthy Alcohol Use launched in October 2019. AHRQ has awarded 3-year grants to six institutions across the country. The grantees will disseminate and implement into primary care practices evidence-based approaches to improve the use of screening for unhealthy alcohol use, brief intervention for those at risk, and medication therapy for alcohol use disorder.
Together, the grantees are expected to work with more than 700 primary care practices. Grantees will receive support from AHRQ through a resource center and participation in a learning community. Grantees will evaluate their dissemination and implementation efforts, and an external evaluator will conduct a cross-grantee evaluation.
This topic is the first of two topics (the other being cardiac rehabilitation) to be funded by AHRQ’s innovative Dissemination and Implementation (D&I) initiative. The goal of the D&I initiative is to identify patient-centered outcomes research (PCOR) findings that are not well delivered in practice and fund programs to increase their uptake and ultimately improve health.
Grantees and Projects
Michigan Sustained Patient-centered Alcohol-Related Care (MI-SPARC) Trial
Principal Investigators: Katharine Bradley, Kaiser Foundation Research Institute, and Anya Day, Altarum Institute
- Test whether the MI-SPARC model increases alcohol screening and brief intervention (SBI) in primary care patients and medication treatment of patients with alcohol use disorders (AUDs), in a stepped-wedge trial with six waves, and
- Test whether adding a novel patient decision aid for AUDs to the MI-SPARC model increases alcohol SBI and medication treatment of patients with AUDs, in a nested two-arm cluster randomized trial.
Practice Facilitation to Promote Evidence-based Screening and Management of Unhealthy Alcohol Use in Primary Care
Principal Investigator: Alexander Krist, Virginia Commonwealth University
- Screening: Evaluate whether practice facilitation increases screening rates for unhealthy alcohol use in primary care.
- Treatment: Evaluate whether practice facilitation increases treatment for unhealthy alcohol use in primary care.
- Practice Implementation and Support Moderators: Understand the practice implementation strategies and practice support factors that influence the effectiveness of the intervention in promoting routine screening for unhealthy alcohol use.
Screening and Management of Unhealthy Alcohol Use in Primary Care: Dissemination and Implementation of PCOR Evidence
Principal Investigator: Daniel Jonas, University of North Carolina at Chapel Hill
- Evaluate the effect of primary care practice facilitation on uptake of evidence-based SBI for unhealthy alcohol use.
- Evaluate the effect of primary care practice facilitation on uptake of evidence-based counseling and medication-assisted treatment (MAT) for AUD.
- For practices with slower uptake, evaluate the effect of providing embedded telehealth services on use of evidence-based SBI for unhealthy alcohol use and counseling and MAT for AUD.
Facilitating Alcohol Screening and Treatment (FAST), Colorado
Principal Investigator: Perry Dickinson, University of Colorado, Denver
- Conduct a cluster randomized trial to examine the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and relative value of two approaches to supporting primary care practices to implement PCOR findings. The focus is on improving identification and treatment of unhealthy alcohol use among adults, including SBI, MAT, and referral to treatment. This trial will investigate the noninferiority from an effectiveness perspective and the superiority from a cost perspective of a virtual practice facilitation intervention. This intervention will feature a practice facilitator working with practices in virtual group sessions using an alcohol use e-learning module to guide and focus the process and content. It will be compared with an in-person practice facilitation intervention.
- Identify key practice characteristics (e.g., practice size, organization type, level of behavioral integration, setting, and level of experience with practice redesign efforts) and other contextual factors that affect the response of practices to the two practice transformation interventions.
- Compare the adaptability, trialability, and scalability of the two interventions to plan dissemination of the findings to key local, regional, and national stakeholders, including sharing ongoing lessons learned and resources with other programs supporting practice transformation.
ANTECEDENT (pArtNerships To Enhance alCohol scrEening, treatment, anD intErveNTion)
Principal Investigators: Melinda Davis and John Muench, Oregon Health & Science University
- Engage, recruit, and conduct intake consultations with 150 primary care clinics and their regional coordinated care organizations within Oregon.
- Implement and describe how practice facilitators tailor implementation support based on context, intervention, and personal expertise using mixed methods and systems science.
- Evaluate the impact of foundational and supplemental implementation support on SBI, MAT, and quality improvement capacity in participating primary care clinics.
Illinois and Wisconsin
INtervention in Small Primary care practices to Implement Reduction in unhealthy alcohol usE (INSPIRE)
Principal Investigators: Abel Kho and Theresa Walunas, Northwestern University
- Develop and deploy a robust online and in-person learning collaborative to support in-clinic implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) and MAT for people with unhealthy alcohol use and identify patients who may benefit from further referral.
- Conduct and assess implementation of a practice-randomized stepped wedge trial in small primary care practices to determine the adoption and efficacy of an electronic health record (EHR)-based workflow to improve screening and treatment for people with unhealthy alcohol use.
- Evaluate the ability of small practices in the region to participate in practice education programs and implement and sustain standard screening and treatment protocols adapted for documentation in the EHR. In addition, identify the factors that facilitated or hindered improvement and sustainability using quantitative and qualitative analysis methods.
Resource Center and Evaluation Contractor
NORC at the University of Chicago; Principal Investigator: Tracy McPherson