Barclay Colleen, Viswanathan Meera, Ratner Shana, Tompkins Julia, Jonas Daniel E
Jt Comm J Qual Patient Saf. 2019 Aug;45(8):566-574. doi: 10.1016/j.jcjq.2019.05.009.
Multiple national organizations recommend screening and counseling adults for unhealthy alcohol use.
An evidence-based approach to screening and counseling using Epic electronic health record (EHR) tools was implemented in a general medicine clinic. A dissemination package with actionable steps for clinics and systems wishing to implement similar processes was then produced. To evaluate the initial implementation and quality improvement project, run charts were created to track patients screened, patients counseled, and fidelity to protocols, and members of the original project team were interviewed to assess facilitators and barriers. The draft dissemination package was revised after feedback from health system representatives (key informants).
More than 9,000 patients (73.9% of those eligible) were screened in 20 months. Sixty-four percent of patients with positive initial screens had documented screening-related assessment; 39.7% (141/355) were offered counseling when indicated. Initial project team members identified EHR tools, clinic leadership, quality improvement culture, a multidisciplinary team, and training for providers and nurses as facilitators; and competing demands, patient population size, and nursing staff/resident turnover as barriers. Six key informants evaluated the dissemination package. Most rated 10 of the 12 sections as very useful; all rated components specific to implementing alcohol screening and counseling as very useful. Ratings for general guidance on implementing evidence-based services in primary care were more mixed.
Evidence-based screening and counseling for unhealthy alcohol use can be implemented with EHR tools. A dissemination guide was viewed favorably by key informants and can serve as a guide for other clinics and systems.
多个国家组织建议对成年人进行不健康饮酒的筛查和咨询。
在一家普通内科诊所实施了一种使用Epic电子健康记录（EHR）工具进行筛查和咨询的循证方法。随后制作了一个传播包，为希望实施类似流程的诊所和系统提供可操作步骤。为评估初始实施情况和质量改进项目，绘制了运行图以跟踪接受筛查的患者、接受咨询的患者以及对协议的依从性，并对原始项目团队成员进行访谈以评估促进因素和障碍。根据卫生系统代表（关键信息提供者）的反馈对传播包草案进行了修订。
在20个月内对9000多名患者（占 eligible患者的73.9%）进行了筛查。初始筛查呈阳性的患者中有64%有记录的与筛查相关的评估；39.7%（141/355）在有指征时接受了咨询。初始项目团队成员确定EHR工具、诊所领导、质量改进文化、多学科团队以及对提供者和护士的培训为促进因素；相互竞争的需求、患者群体规模以及护理人员/住院医师更替为障碍。6名关键信息提供者对传播包进行了评估。大多数人将12个部分中的10个评为非常有用；所有人都将实施酒精筛查和咨询的特定组件评为非常有用。对在初级保健中实施循证服务的一般指导的评分则更为参差不齐。
使用EHR工具可以实施针对不健康饮酒的循证筛查和咨询。关键信息提供者对传播指南评价良好，可作为其他诊所和系统的指南。
