Michigan SPARC Trial

Not Applicable

Completed

• Conditions: Alcohol; Drinking; Alcohol Use Disorder (AUD)
• Interventions: Behavioral: Michigan SPARC Quality Improvement Intervention

• Registration Number: NCT04861792
• Lead Sponsor: Kaiser Permanente

Brief Summary

Unhealthy alcohol use is a major contributor to morbidity and mortality in the US. Although effective prevention for unhealthy alcohol use and medication treatment for alcohol use disorders (AUDs) can be provided in primary care (PC), they have historically not been included in routine services. As a result, most patients do not receive evidence-based prevention or treatment for unhealthy alcohol use. Several efforts have successfully implemented alcohol-related preventive care-referred to as screening and brief intervention (SBI), but efforts to increase treatment of AUDs with medications have been less successful. Moreover, implementation efforts have usually neglected smaller PC practices, in which most PC is provided.

The Michigan SPARC trial is a partnership between Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle, bringing extensive expertise implementing evidence-based alcohol-related care, and Altarum Institute in Ann Arbor, Michigan, bringing demonstrated success engaging over 500 small to medium Michigan-based PC practices in effective quality improvement (QI) efforts. The project builds on Altarum's innovative approach to implementing new or improved clinical care using practice facilitators to provide continuing medical education and maintenance of certification (CME/MOC) programs to PC providers, along with ongoing support for QI using evidence-based implementation strategies. The KPWHRI team recently finished the highly successful AHRQ-funded Sustained Patient-centered Alcohol-Related Care (SPARC) trial using similar implementation strategies in KP Washington, including use of electronic health records and performance monitoring and feedback, and also developed a patient decision aid to support shared decision-making between patients with high-risk drinking and/or AUDs and their PC providers.

The Michigan SPARC trial combines Altarum's expertise in QI in small-medium PC practices in Michigan with KPWHRI's expertise implementing evidence-based prevention and treatment of unhealthy alcohol use-specifically alcohol SBI and medication treatment for AUDs.

Specific Aims of the Michigan SPARC trial had to be markedly modified due to the trial beginning in March 2020 at the same time as the COVID pandemic. A trial was not possible. The revised aims were to describe alcohol screening, brief intervention, AUD diagnosis and initiation of medication treatment for AUD, before and after the Michigan SPARC model was implemented, in small to medium PC practices in Michigan.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2021-04-21
• Study First Submitted QC: 2021-04-26
• Study First Posted: 2021-04-27
• Study Start: 2021-05-01
• Status Verified: 2023-03
• Primary Completion: 2023-03-13
• Study Completion: 2023-03-13
• Last Update Submitted: 2023-03-23
• Last Update Posted: 2023-03-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 9590

Inclusion Criteria

• Adults age 18 years and older
• Seen in primary care at a study practice during the practice's study period

Exclusion Criteria

• None

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Quality Improvement Intervention	Michigan SPARC Quality Improvement Intervention	Patients seen after the intervention launch date.

Primary Outcome Measures

Name	Time	Method
Prevention - Screening and brief intervention	For Aim 1 the period up to 6 months before the launch date will be compared to the 6 month period after the launch date.	The proportion of PC patients who screen positive for unhealthy alcohol use and have BI documented in their EHR.
Treatment - Prescription of AUD medications	For Aim 1 the period up to 6 months before the launch date will be compared to the 6 month period after the launch date.	The proportion of PC patients who are diagnosed with AUD at a visit who also receive a prescription for medications to treat AUD and are seen for follow-up within 14 days.

Trial Locations

Locations (1)

Altarum Institute; 🇺🇸 Ann Arbor, Michigan, United States