The Michigan Sustained Patient-centered Alcohol-Related Care (MI-SPARC) Trial

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Project 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 proposed project 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 such as depression screening, oral healthcare, or safer opioid prescribing in PC. Altarum's approach uses 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, 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 proposed Michigan SPARC (MI-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, sometimes called MAT, for “medication-assisted therapy”. Specific Aims of the MI-SPARC trial are to: 1. Test whether the MI-SPARC model increases (a) alcohol SBI and/or (b) initiation of medication treatment for AUDs, in small to medium PC practices in Michigan, in a stepped-wedge trial with 6 waves, and 2. Test whether adding an innovative decision aid for AUDs to MI-SPARC implementation increases rates of (a) SBI, and/or (b) initiation of medication treatment for AUDs, in a nested two-arm cluster randomized trial. Public Health Impact. Despite consolidation of PC into large systems, 58% of PC in the US is still provided by small-medium practices. Decreasing morbidity and mortality of unhealthy alcohol use therefore requires adapting and testing approaches to improving alcohol-related care in these PC practices. The MI-SPARC team is uniquely qualified to lead such an effort, in collaboration with AHRQ's national evaluation.