Records for Alcohol Care Enhancement
- Conditions
- Alcohol Use Disorder (AUD)
- Interventions
- Behavioral: Best Practice Advisory (BPA) and Clinical Care Management (CCM)Behavioral: Best Practice Advisory (BPA) and Population Health Management (PHM)Behavioral: Best Practice Advisory (BPA) and Population Health Management (PHM) and Clinical Care Management (CCM)
- Registration Number
- NCT05492942
- Lead Sponsor
- Boston Medical Center
- Brief Summary
Unhealthy alcohol use (the spectrum from risky consumption through alcohol use disorder, AUD) is a leading cause of preventable death in the US (88,424 deaths annually costing $249 billion a year), and alcohol-related health harms (e.g. AUD itself, cirrhosis) are increasing. Despite high frequency of contacts with the medical system, most people with unhealthy alcohol use do not receive evidence-based interventions due to factors such as stigma, lack of knowledge, challenges with implementing and maintaining tool-based screening, time or prioritization constraints, and more.
Electronic health records (EHRs), Best Practice Advisories (BPA) and registries are known and practical tools to improve management and care of chronic disease by aggregating information about the target population, and by assisting the clinician in reminders, decision support, and disease-specific care management. EHRs may help clinicians identify, assess, treat and monitor care when assisted by targeted staff support such as a clinical care manager (CCM) and population health manager (PHM). These support staff help to track outcomes of care and treatments, allowing for increased engagement with the population, and facilitation of care.
The study team created a live database/registry of patients with unhealthy alcohol use in the BMC electronic health record (Epic), and updated Epic-based best practice advisories (BPA) and clinical decision support (CDS) (Epic Smart Set) for risky alcohol use and AUD. To improve recognition, management, and overall services provided to patients with AUD, this trial aims to test the impact of these EHR tools (the BPA, CDS, registry and registry-based reporting) for risky alcohol use and AUD by incorporating a population health manager (PHM) and clinical care manager (CCM) to augment reach and support to clinicians, and test the feasibility and effectiveness of leveraging EHRs and targeted supports to improve AUD care. A four-group randomized control trial will be implemented to determine which of four interventions is most effective at increasing rates of initiation and engagement in AUD treatment, as well as other clinical processes and outcomes. The trial will compare the use of the 1) BPA alone (only Epic-based clinician prompting and CDS), 2) BPA + PHM, 3) BPA + CCM, and 4) BPA + PHM + CCM, on the trials' primary, secondary, and exploratory outcomes. Trial results will be assessed by examining outcomes for patients on the clinician's panel.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 134
Not provided
• Clinicians who, at the time of study recruitment, are expected to remain in their BMC GIM position for less than 18 months (e.g. resident or fellow trainees expected to graduate within the study time period).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description BPA plus Clinical Care Management (BPA+CCM) Best Practice Advisory (BPA) and Clinical Care Management (CCM) Access to the existing Epic BPA for risky alcohol use and alcohol use disorder + targeted support by a clinician care manager (CCM). BPA plus Population Health Management (BPA+PHM) Best Practice Advisory (BPA) and Population Health Management (PHM) Access to the existing Epic BPA for risky alcohol use and alcohol use disorder + targeted support by a population health manager (PHM). BPA plus Population Health Management plus Clinical Care Management (BPA+PHM+CCM) Best Practice Advisory (BPA) and Population Health Management (PHM) and Clinical Care Management (CCM) Access to the existing Epic BPA risky alcohol use and alcohol use disorder + targeted support by a population health manager (PHM) and clinician care manager (CCM)
- Primary Outcome Measures
Name Time Method Percent Engaged in Alcohol Use Disorder (AUD) Treatment 48 days The percent of patients engaged in AUD treatment among patients with a new AUD diagnosis on a clinician's panel. Engagement is defined as having two or more healthcare services (inclusive of AUD medication) with a diagnosis of AUD within 34 days of meeting initiation which is defined as having a healthcare service for AUD within 14 days of a new AUD diagnosis. A new AUD diagnosis is defined as a health service in which a patient receives a new AUD diagnosis when there has not been an AUD diagnosis during the prior 194 days, excluding diagnoses assigned in the emergency department/detox.
- Secondary Outcome Measures
Name Time Method Percent Initiated in Alcohol Use Disorder (AUD) Treatment 14 Days The percent of patients initiated in AUD treatment among patients with a new AUD diagnosis on a clinician's panel. Initiation is defined as having a healthcare service (inclusive of medication) with a diagnosis of AUD within 14 days of a new AUD diagnosis. A new AUD diagnosis is defined as a health service in which a patient receives a new AUD diagnosis when there has not been an AUD diagnosis during the prior 194 days, excluding diagnoses assigned in the emergency department/detox.
Percent Prescribed Alcohol Use Disorder (AUD) Medication 90 Days The percent of patients who have been prescribed AUD medication such as Naltrexone, Intramuscular (IM) Naltrexone, Acamprosate, or Disulfiram within 90 days of a new AUD diagnosis, among patients with a new AUD diagnosis on a clinician's panel.
Number of Outpatient Visits for Alcohol Use Disorder (AUD) 90 Days Number of Boston Medical Center (BMC) outpatient encounters with an AUD billing diagnosis within 90 days of a new AUD diagnosis, among patients with a new AUD diagnosis on a clinician's panel.
Number of Visits with a BMC mental health clinician for Alcohol Use Disorder (AUD) 90 Days Number of visits with a BMC mental health clinician with an AUD diagnosis (encounter with AUD as a billing diagnosis) within 90 days of a new AUD diagnosis, among patients with a new AUD diagnosis on a clinician's panel.
Number of Referral(s) for Counseling or Specialty Alcohol Use Disorder (AUD) Care 90 Days Number of referrals for counseling or specialty AUD care such as the BMC Office Based Addiction Treatment (OBAT), Center for Addiction Treatment for AdoLescent/Young adults who use SubsTances (CATALYST), etc., within 90 days of a new AUD diagnosis, among patients with a new AUD diagnosis on a clinician's panel.
Number Completed Encounter for Alcohol Use Disorder (AUD) Specialty Care 90 Days Number of completed encounters for AUD specialty care in the electronic health record (EHR) within 90 days of a new AUD diagnosis, among patients with a new AUD diagnosis on a clinician's panel.
Number of Acute Care Utilization 90 Days Number of acute care utilization encounters (emergency department visits and hospitalizations) within 90 days of a new AUD diagnosis, among patients with a new AUD diagnosis on a clinician's panel.
Number of Acute Care Utilization with an Alcohol-related Diagnosis 90 Days Number of acute care utilization encounters (emergency department visits and hospitalizations), with an alcohol-related diagnosis within 90 days of a new AUD diagnosis, among patients with a new AUD diagnosis on a clinician's panel.
Trial Locations
- Locations (1)
General Internal Medicine Primary Care Suites, BU Medical Campus
🇺🇸Boston, Massachusetts, United States