INtervention in Small Primary care practices to Implement Reduction in unhealthy alcohol usE (INSPIRE)

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ABSTRACT Unhealthy alcohol use is a leading cause of preventable mortality and a risk factor for an array of social and health problems with an estimated annual economic impact of $249 billion. Despite the significant public health impact of unhealthy alcohol use, rates of screening across the country remain low. In Illinois and Wisconsin, two states with the highest levels of unhealthy alcohol use in the Midwest, less than 17% of patients receive screening in a primary care setting and only 5% of patients with reported heavy alcohol use receive treatment. Effective screening and treatment in small practices is limited by lack of clinician education around screening and management, low rates of prescribing medications for alcohol use disorder, poor availability of referral programs, and difficulty integrating interventions into existing clinical workflows. Checklist-based screening tools present a simple, easy to understand strategy and have been successfully applied within the healthcare setting. In this project, we aim to test the feasibility and effectiveness of office-based screening supported by behavioral and medication-based interventions in primary care practices, through an integrated platform of education, practice facilitation, and embedded EHR technology. The project brings together a complementary team of experts from academic institutions, a quality improvement organization, practice-based research networks and independent research organizations, a majority of whom have previously worked together to implement similar office-based interventions supported by practice facilitation to improve cardiovascular care. Our specific aims are to 1) Develop and deploy online CME education programs to support the in-clinic implementation of behavioral intervention and medication assisted treatment for people with unhealthy alcohol use and identify patients who may benefit from further referral. 2) Conduct a practice randomized stepped wedge trial in small primary care practices to determine the adoption and efficacy of an EHR-based checklist to improve screening and treatment for people with unhealthy alcohol use. 3) Evaluate the ability of small practices in our region to participate in practice education programs and implement and sustain standard screening and treatment protocols adapted for documentation in the EHR and identify the factors that facilitated or hindered improvement and sustainability using quantitative and qualitative analysis methods. An important outcome of our program will be a robust, sustainable education and quality improvement infrastructure that can be deployed and disseminated throughout our region to support reduction of unhealthy alcohol use.