Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief

Measure Specification

This measure is intended to promote unhealthy alcohol use screening and brief counseling which have been shown to be effective in reducing alcohol consumption, particularly in primary care settings. A number of studies, including patient and provider surveys, have documented low rates of alcohol misuse screening and counseling in primary care settings.

According to a study analyzing the quality of health care in the United States, on average, 45% of patients (n=6,676) were screened for problem drinking.. In the national Healthcare for Communities Survey, only 8.7% of problem drinkers reported having been asked and counseled about their alcohol use in the last 12 months. A nationally representative sample of 648 primary care physicians were surveyed to determine how such physicians identify--or fail to identify--substance abuse in their patients, what efforts they make to help these patients and what are the barriers to effective diagnosis and treatment.

Of physicians who conducted annual health histories, less than half ask about the quantity and frequency of alcohol use (45.3 percent). Only 31.8 percent say they ever administer standard alcohol or drug use screening instruments to patients.. A national systematic sample of 2,000 physicians practicing general internal medicine, family medicine, obstetrics-gynecology, and psychiatry were surveyed to determine the frequency of screening and intervention for alcohol problems.

Of the 853 respondent physicians, 88% usually or always ask new outpatients about alcohol use. When evaluating patients who drink, 47% regularly inquire about maximum amounts on an occasion, and 13% use formal alcohol screening tools. Only 82% routinely offer intervention to diagnosed problem drinkers.. In 2014, the CDC analyzed data from 17 states and the District of Columbia via the Behavioral Risk Factor Surveillance System to estimate the prevalence of adults who reported receiving elements of alcohol screening and brief intervention.

While 77.7% of adults reported being asked about alcohol use by a health professional, only 32.9% were asked about binge-level alcohol consumption and among binge drinkers only 37.2% reported being counseled on the harms of binge drinking. Only 18.1% reported being advised to cut down on alcohol consumption or to quit drinking.. A multi-site, cross-sectional survey of primary care residents from six primary care residency programs administered from March 2010 through found that a minority of the residents appropriately screen or provide intervention for at risk alcohol users.

While 60% (125/208) stated they screen patients at an initial visit, only 17% (35/208) screened patients at subsequent visits. 54% (108/202) reported they did not feel they had adequate training to provide brief intervention to patients found to be at-risk alcohol users and 21% (43/208) felt they could really help at-risk drinkers.. A study evaluating self- reported prevalence of alcohol screening using information drawn from the ConsumerStyles survey (a random internet panel) found that only 24.

7% (n=2,592) of adults reported being asked about their alcohol use. While prevalence among men and women were about the same, there was lower prevalence of screening among Black non-Hispanics than white non-Hispanics (16.2% vs. 26.9%) and college graduates reported a higher prevalence of screening than those with a high school degree or less (38.1% vs.

20.8%).. A cross-sectional analysis using 2016 DocStyles data that evaluated with use of different screening tools used to screen for alcohol misuse by 1,506 primary care providers found that while most providers screen for alcohol misuse (96%) only 38% reported using a USPSTF recommended screening tool..

The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. (Grade B recommendation) (USPSTF, 2018)

This measure contains three strata defined by three submission criteria. This measure produces three performance rates. There are 3 Submission Criteria for this measure: 1) All patients who were screened for unhealthy alcohol use using a systematic screening method. AND 2) All patients who were identified as unhealthy alcohol users who received brief counseling.

AND 3) All patients who were screened for unhealthy alcohol use using a systematic screening method and, if identified as unhealthy alcohol users received brief counseling, or were not identified as unhealthy alcohol users. This measure contains three submission criteria which aim to identify patients who were screened for unhealthy alcohol use using a systematic screening method (Submission Criteria 1), patients who were identified as unhealthy alcohol users and who received brief counseling (Submission Criteria 2), and a comprehensive look at the overall performance on unhealthy alcohol use screening and brief counseling (Submission Criteria 3).

By separating this measure into various submission criteria, the MIPS eligible clinician will be able to better ascertain where gaps in performance exist and identify opportunities for improvement. For the purposes of submitting this measure, use the Data Completeness determined in Submission Criteria 1. This measure will be calculated with 3 performance rates: 1) Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months.

2) Percentage of patients aged 18 years and older who were identified as unhealthy alcohol users who received brief counseling. AND 3) Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 12 months AND who received brief counseling if identified as unhealthy alcohol users.

The overall rate (Submission Criteria 3) should be utilized to compare performance to published versions of this measure prior to the 2021 performance year, when the measure had a single performance rate. For accountability reporting in the CMS MIPS program, the rate for Submission Criteria 2 is used for performance. For the purposes of MIPS implementation of this measure, this patient-process measure is submitted a minimum of once per patient during the performance period.

The most advantageous quality data code (QDC) will be used if the measure is submitted more than once. For the purposes of the measure, the most recent denominator eligible encounter should be used to determine if the numerator action for the submission criteria was performed within the 12-month look back period. The denominator of Submission Criteria 2 is a subset of the resulting numerator for Submission Criteria 1, as Submission Criteria 2 is limited to assessing if patients identified as unhealthy alcohol users received brief counseling.

For all patients, Submission Criteria 1 and 3 are applicable, but Submission Criteria 2 will only be applicable for those patients who are identified as unhealthy alcohol users. Therefore, data for every patient that meets the age and encounter requirements will only be submitted for Submission Criteria 1 and 3, whereas data submitted for Submission Criteria 2 will be for a subset of patients who meet the age and encounter requirements, as the denominator has been further limited to those who were identified as unhealthy alcohol users.