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The American Journal of Managed Care October 2006
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Implementation of Evidence-based Alcohol Screening in the Veterans Health Administration
Katherine A. Bradley, MD, MPH; Emily C. Williams, MPH; Carol E. Achtmeyer, MN; Bryan Volpp, MD; Bonny J. Collins, PA-C, MPA; and Daniel R. Kivlahan, PhD
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Outpatient Medication Use and Health Outcomes in Post-Acute Coronary Syndrome Patients
Zhou Yang, PhD, MPH; Ade Olomu, MD; William Corser, PhD; David R. Rovner, MD; and Margaret Holmes-Rovner, PhD
Implementation of Evidence-based Alcohol Screening in the Veterans Health Administration
Katherine A. Bradley, MD, MPH; Emily C. Williams, MPH; Carol E. Achtmeyer, MN; Bryan Volpp, MD; Bonny J. Collins, PA-C, MPA; and Daniel R. Kivlahan, PhD
Association of Income and Prescription Drug Coverage With Generic Medication Use Among Older Adults With Hypertension
Alex D. Federman, MD, MPH; Ethan A. Halm, MD, MPH; Carolyn Zhu, PhD; Tsivia Hochman, MA; and Albert L. Siu, MD, MSPH
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Steven Lewandowski, BSS; Patrick J. O'Connor, MD, MPH; Leif I. Solberg, MD; Thomas Lais, BS; Mary Hroscikoski, MD; and JoAnn M. Sperl-Hillen, MD
Increasing Primary Care Physician Productivity: A Case Study
Steven Lewandowski, BSS; Patrick J. O'Connor, MD, MPH; Leif I. Solberg, MD; Thomas Lais, BS; Mary Hroscikoski, MD; and JoAnn M. Sperl-Hillen, MD

Implementation of Evidence-based Alcohol Screening in the Veterans Health Administration

Katherine A. Bradley, MD, MPH; Emily C. Williams, MPH; Carol E. Achtmeyer, MN; Bryan Volpp, MD; Bonny J. Collins, PA-C, MPA; and Daniel R. Kivlahan, PhD

To conclude, the VA has successfully initiated screening for risky drinking and for alcohol use disorders as the essential first step toward implementing brief alcohol counseling. This collaboration between implementation researchers and quality improvement leaders relied predominantly on an incentive system and on an electronic medical record, combined with technical and educational support, to promote alcohol misuse screening. However, the ultimate goal is far more ambitious, namely, to create incentives and systems of care that will decrease alcohol misuse, thereby preventing alcohol- related morbidity and mortality. Therefore, the next challenge is to implement effective follow-up for alcohol misuse in this large multisite healthcare system.

Acknowledgments

We acknowledge the VA Office of Quality and Performance for the use of quality improvement data presented in this article and for helpful consultation. In addition, we thank Kinsey McCormick and Anna DeBenedetti for assistance with the preparation of the manuscript.




From Health Services Research and Development (KAB, ECW, CEA, DRK) and Primary and Specialty Medical Care (KAB, CEA), VA Puget Sound Health Care System; Center of Excellence in Substance Abuse Treatment and Education (KAB, ECW, DRK); and Departments of Medicine (KAB, ECW), Health Services (KAB), and Psychiatry and Behavioral Sciences (DRK), University of Washington, Seattle; VA Northern California Healthcare System, Martinez (BV); and VA Office of Quality and Performance, Washington, DC (BJC).

This study was supported by the Health Services Research and Development Service, Department of Veterans Affairs, Veterans Health Administration (VA). The manuscript was prepared with support by grant SUB 98-000 from the VA Substance Use Disorders Quality Enhancement Research Initiative and Center of Excellence in Substance Abuse Treatment and Education. Dr Bradley was also supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) K23 Career Development Award K23AA00313 and was a Robert Wood Johnson (RWJ) Generalist Physician Faculty Scholar at the time much of the work was conducted. Drs Bradley and Kivlahan serve as the clinical coordinators of the VA Substance Use Disorders Quality Enhancement Research Initiative.

Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, the NIAAA, or the RWJ Foundation.

Address correspondence to: Katharine A. Bradley, MD, MPH, Health Services Research and Development (152), VA Puget Sound Health Care System, 1100 Olive Way, Ste 1400, Seattle, WA 98101. E-mail: willi@u.washington.edu.


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