*Health Services Research & Development (HSR&D) Northwest Center of Excellence †Department of Health Services, University of Washington ‡Group Health Research Institute §Department of Biostatistics, University of Washington ∥Center of Excellence in Substance Abuse Treatment and Education (CESATE) Departments of ¶Psychiatry and Behavioral Sciences #Medicine, University of Washington, Seattle, WA.
Med Care. 2013 Oct;51(10):914-21. doi: 10.1097/MLR.0b013e3182a3e549.
Routine alcohol screening is widely recommended, and Medicare now reimburses for annual alcohol screening. Although up to 18% of patients will screen positive for alcohol misuse, the value of annual rescreening for patients who repeatedly screen negative is unknown.
To evaluate the probability of converting to a positive alcohol screen at annual rescreening among VA outpatients who previously screened negative 2-4 times.
Retrospective cohort study.
A total of 179,035 VA outpatients (10,588 women) who previously screened negative on 2 and up to 4 consecutive annual alcohol screens and were rescreened the next year.
AUDIT-C alcohol screening scores (range, 0-12) were obtained from electronic medical record data. The probability of converting to a positive screen (scores: men ≥4; women, ≥3) at rescreening after 2-4 prior negative screens was evaluated overall and across subgroups based on age, sex, and prior negative screen scores (scores: men, 0-3; women, 0-2).
The overall probability of converting to a positive subsequent screen decreased modestly from 3.5% to 1.9% as the number of prior consecutive negative screens increased from 2 to 4, yet varied widely across subgroups based on age, sex, and prior negative screen scores (0.6%-38.7%).
The likelihood of converting to a positive screen at annual rescreening is strongly influenced by age, sex, and scaled screening scores on prior negative alcohol screens. Algorithms for the frequency of repeat alcohol screening for patients who repeatedly screen negative should be based on these factors. These results may have implications for other routine behavioral health screenings.
常规酒精筛查得到广泛推荐，医疗保险现在报销年度酒精筛查费用。尽管多达 18%的患者会出现酒精滥用筛查阳性，但反复筛查阴性患者进行年度复查的价值尚不清楚。
评估 VA 门诊患者在之前连续 2-4 次筛查阴性后，在年度复查时转为阳性酒精筛查的可能性。
回顾性队列研究。
共有 179035 名 VA 门诊患者（10588 名女性），他们之前连续 2 次及以上年度酒精筛查结果为阴性，并在次年再次接受筛查。
从电子病历数据中获取 AUDIT-C 酒精筛查评分（范围：0-12）。评估在之前 2-4 次阴性筛查后，在次年再次筛查时转为阳性筛查（评分：男性≥4；女性，≥3）的概率，总体和根据年龄、性别和之前阴性筛查评分（评分：男性，0-3；女性，0-2）进行亚组分析。
总体而言，随着之前连续阴性筛查次数从 2 次增加到 4 次，转为随后阳性筛查的概率从 3.5%适度下降至 1.9%，但在亚组之间差异很大，这取决于年龄、性别和之前阴性筛查评分（0.6%-38.7%）。
在年度复查时转为阳性筛查的可能性受到年龄、性别和之前阴性酒精筛查的评分标准的强烈影响。对于反复筛查阴性的患者，重复酒精筛查的频率算法应基于这些因素。这些结果可能对其他常规行为健康筛查有影响。
